USMLE STEP 3 MCQ 50:A 52 year old white male is found to have some abnormalities in his peripheral blood smear

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Question:
A 52 year old white male is found to have some abnormalities in his peripheral blood smear. He has anti-intrinsic factor antibodies in his serum. He has a positive Schilling test. He is given a diagnosis of pernicious anemia. He is told that on his differential count, the abnormality was a shift to the right. What is a 'shift to the right'?

a) increased number of white blood cells in the peripheral blood
b) decreased number of white blood cells in the peripheral blood
c) hypersegmented granulocytes present in the peripheral blood
d) increased number of immature white blood cells in the peripheral blood
e) increased number of immature red blood cells in the peripheral blood

 
Correct Answer: C

Explanation:


Hypersegmented changes in the white blood cells is referred to as right shift. This also indicates that there are few immature cells in the differential.A increased number of white blood cells in the peripheral blood (choice a) is called a leukocytosisA decreased number of white blood cells in the peripheral blood (choice b) is called a leukopenia.An increased number of immature white blood cells in the peripheral blood (choice d) is a left shift, or a shift to the left.An increased number of immature red blood cells in the peripheral blood (choice e) is a reticulocytosis


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