NNP Hematology and Hyperbilirubinemia 3

Question 1

A term neonate has a central hematocrit of 68% at 12 hours of age and is asymptomatic. What is the MOST appropriate management?

Accepted Answer

Partial exchange transfusion only if symptomatic or hematocrit ≥65% with symptoms

Answer

Immediate partial exchange transfusion with normal saline

Answer

Increased oral feeding and repeat hematocrit in 4–6 hours

Answer

Phlebotomy without volume replacement

Question 2

Which of the following is the MOST common cause of anemia in a preterm neonate in the first week of life?

Accepted Answer

Iatrogenic blood loss from phlebotomy

Answer

Hemolytic disease of the newborn

Answer

Twin-to-twin transfusion syndrome

Answer

Hereditary spherocytosis

Question 3

What hematocrit threshold typically triggers packed red blood cell (pRBC) transfusion in a clinically stable preterm neonate on minimal respiratory support?

Accepted Answer

Hematocrit < 25% with symptoms or < 21% if asymptomatic

Answer

Hematocrit < 35%

Answer

Hematocrit < 40%

Answer

Hematocrit < 30% regardless of symptoms

Question 4

A neonate born via emergency cesarean section for placental abruption presents at 10 minutes of life with pallor, poor perfusion, and a hematocrit of 28%. Which diagnosis should be suspected?

Accepted Answer

Acute fetal-maternal hemorrhage or abruptio placentae causing hypovolemic anemia

Answer

Polycythemia from delayed cord clamping

Answer

Rh hemolytic disease of the newborn

Answer

Disseminated intravascular coagulation (DIC)

Question 5

Which coagulation profile is most consistent with Disseminated Intravascular Coagulation (DIC) in a neonate?

Accepted Answer

Elevated PT, elevated aPTT, low fibrinogen, low platelets, elevated D-dimers

Answer

Normal PT, isolated elevated aPTT, normal platelets

Answer

Low PT, normal aPTT, high fibrinogen, elevated platelets

Answer

Elevated PT, normal aPTT, normal fibrinogen, normal platelets

Question 6

A neonate presents with prolonged aPTT, normal PT, normal platelet count, and a history of a circumcision bleed. Which diagnosis is MOST likely?

Accepted Answer

Hemophilia A (Factor VIII deficiency)

Answer

Vitamin K deficiency bleeding

Answer

Disseminated intravascular coagulation

Answer

Bernard-Soulier syndrome

Question 7

Which vitamin K-dependent clotting factors are deficient in hemorrhagic disease of the newborn (HDN)?

Accepted Answer

Factors II, VII, IX, and X

Answer

Factors I, II, III, IV

Answer

Factors VIII, IX, XI, and XII

Answer

Factors V, VIII, and von Willebrand factor