Question 1

What are the bone marrow findings in hemolytic anemia?&#10;A)myeloid-to-erythroid (M:E) ratio of 1:1&#10;B)M:E ratio of 5:1&#10;C)reduced cellularity and increased fat&#10;D)erythroid hypoplasia

Accepted Answer

Erythropoiesis is increased (erythroid hyperplasia)in the bone marrow in hemolytic anemia,with no change in the production of granulocytes.The M:E ratio will therefore be decreased (i.e.,more erythroid precursors relative to myeloid).Overall cellularity of the bone marrow is increased so that less fat exists.

Question 2

What characteristic red cell shape is associated with extravascular hemolysis?&#10;A)spherocyte&#10;B)schistocyte&#10;C)target cell&#10;D)burr cell

Accepted Answer

Spherocytes suggest extravascular hemolysis.

Question 3

Which of the following are typical findings in extravascular hemolysis?&#10;A)increased serum and urine conjugated bilirubin&#10;B)increased serum and urine unconjugated bilirubin&#10;C)increased serum unconjugated bilirubin and increased urine urobilinogen&#10;D)decreased urine and stool conjugated bilirubin

Accepted Answer

During the process of extravascular hemolysis,macrophages phagocytize and break down hemoglobin into its various component parts.Unconjugated bilirubin is thus increased.This is taken to the liver,where it is conjugated.Bacteria in the gut oxidize conjugated bilirubin into various water-soluble compounds that together are called urobilinogen.Some of this is reabsorbed into the plasma and because of its water solubility will be filtered by the renal glomerulus and excreted into urine.This results in an increase in urobilinogen in the urine.

Question 4

Unconjugated or indirect bilirubin is normally found in&#10;A)plasma&#10;B)erythrocytes&#10;C)urine&#10;D)intestines

Accepted Answer

The bilirubin originally released from macrophages after degradation of the protoporphyrin ring is normally found in plasma before conjugation in the liver.

Question 5

Which of the following clinical findings specifically suggests,if it is present,extravascular hemolysis?&#10;A)increased heart rate&#10;B)splenomegaly&#10;C)pallor&#10;D)fatigue

Accepted Answer

A chronic extravascular hemolytic process can lead to an enlarged spleen (splenomegaly).All of the other clinical findings listed may be found in anemia because of any cause-they are nonspecific findings.

Question 6

A plasma sample appears hemolyzed or red.Which of the following is true?&#10;A)The patient has extravascular hemolysis.&#10;B)The patient has increased haptoglobin.&#10;C)The patient has increased hemopexin.&#10;D)The plasma hemoglobin is greater than 50 mg/dL.

Accepted Answer

Plasma hemoglobin can be detected when the concentration of hemoglobin is greater than 50 mg/dL.Free hemoglobin is seen in plasma,giving it its red color when excessive intravascular hemolysis exists.Both haptoglobin and hemopexin will be decreased as an attempt to salvage iron occurs.

Question 7

Which of the following test results suggests red blood cell (RBC)survival is significantly decreased from the normal of 120 days?&#10;A)decreased glycated hemoglobin&#10;B)a T1/2 Cr of 30 days&#10;C)normal haptoglobin&#10;D)decreased lactic dehydrogenase

Accepted Answer

Glycated hemoglobin increases over the life of the red cell as it (the red cell and thus hemoglobin)is continually exposed to glucose in plasma.In hemolytic disease,the red cells have a shortened survival and thus less exposure to glucose,which results in a lower glycated hemoglobin than normal.Haptoglobin is an acute phase protein and may be normal or even increased even in intravascular hemolysis if the patient has concurrent inflammation;thus a normal haptoglobin does not rule out intravascular hemolysis with a shortened RBC survival.Lactic dehydrogenase is released from lysed red cells and increases when RBC survival is shortened.A T₁/₂ Cr of 30 days is normal.

Question 8

Which of the following suggests ongoing hemolysis in a patient who has not had massive blood loss or been hemodiluted?&#10;A)reticulocyte production index (RPI) of 1&#10;B)reticulocyte count of 1.3%&#10;C)drop in hemoglobin of 1.3 g/dL in 1 week&#10;D)hemoglobin falling 0.5 g/dL

Accepted Answer

A drop in the hemoglobin by greater than 1 g/dL/week can signal ongoing hemolysis provided the clinician has ruled out hemorrhage and hemodilution.

Question 9

Which of the following is the most specific indicator of accelerated intravascular red cell destruction?&#10;A)increased serum bilirubin&#10;B)increased haptoglobin&#10;C)decreased hematocrit&#10;D)decreased haptoglobin

Accepted Answer

When red cells are destroyed in the circulation,hemoglobin is released into plasma.Haptoglobin binds the free hemoglobin and thus decreases in plasma.This is specific for intravascular hemolysis.

Question 10

Laboratory tests indicate that an female adult has an increased rate of red cell destruction in the circulation.Her hematocrit is 39%.Which of the following describes her hemolytic disorder?&#10;A)mild&#10;B)moderate&#10;C)acute&#10;D)compensated

Accepted Answer

This patient is not anemic,so this is a compensated hemolytic disorder.The response to anemia is to increase the rate of red cell production and release to peripheral blood.When the marrow response is robust enough to keep up with the rate of red cell destruction,anemia does not develop and the result is a compensated hemolytic disorder.

Question 11

All of the following are often seen in various types of hemolytic anemia except&#10;A)schistocytes.&#10;B)spherocytes.&#10;C)polychromasia.&#10;D)hypochromasia.

Accepted Answer

The answer of All of the following are often seen...

Question 12

A patient develops an immunoglobulin G (IgG)antibody that causes red cells to be destroyed by the spleen.This is what type of hemolysis?&#10;A)inherited, intrinsic, extravascular, immune&#10;B)acquired, extrinsic, extravascular, immune&#10;C)acquired, intrinsic, intravascular, immune&#10;D)acquired, extrinsic, intravascular, traumatic

Accepted Answer

The answer of A patient develops an immunoglobulin G (IgG)antibody...

Question 13

An elevated reticulocyte count rules out which of the following?&#10;A)acute blood loss&#10;B)aplastic crisis&#10;C)acute hemolysis&#10;D)successful patient response to iron therapy

Accepted Answer

The answer of An elevated reticulocyte count rules out which...

Question 14

Which of the following is decreased in intravascular hemolysis?&#10;A)haptoglobin&#10;B)urine hemoglobin&#10;C)serum hemoglobin&#10;D)urine urobilinogen

Accepted Answer

The answer of Which of the following is decreased in...

Question 15

Which of the following tests for hemolysis is easiest and safest for the patient?&#10;A)reticulocyte count&#10;B)red cell survival with labeled chromium&#10;C)bone marrow biopsy&#10;D)cross-transfusion studies

Accepted Answer

The answer of Which of the following tests for hemolysis...

Question 16

Which of the following breakdown products of hemoglobin is removed from the body instead of being recycled?&#10;A)globin&#10;B)amino acids&#10;C)protoporphyrin ring&#10;D)iron

Accepted Answer

The answer of Which of the following breakdown products of...

Question 17

The presence of hemoglobinuria,hemosiderinuria,and hemoglobinemia indicate that hemolysis is&#10;A)severe.&#10;B)acquired.&#10;C)compensated.&#10;D)intravascular.

Accepted Answer

The answer of The presence of hemoglobinuria,hemosiderinuria,and hemoglobinemia indicate that...

Question 18

How are normal red cells removed when they lose the ability to deform?&#10;A)After 120 days, most are phagocytized by splenic macrophages.&#10;B)After 10 to 14 days, most are phagocytized by splenic macrophages.&#10;C)After 10 to 14 days, most are destroyed by complement.&#10;D)After 120 days, most are destroyed inside the blood vessels.

Accepted Answer

The answer of How are normal red cells removed when...

Question 19

Which of the following is found normally in urine?&#10;A)conjugated bilirubin&#10;B)urobilinogen&#10;C)stercobilin&#10;D)unconjugated bilirubin

Accepted Answer

The answer of Which of the following is found normally...

Question 20

A urine sediment stains with Prussian blue.The patient probably has&#10;A)hemoglobinemia.&#10;B)a membrane defect.&#10;C)compensated hemolysis.&#10;D)extravascular hemolysis.

Accepted Answer

The answer of A urine sediment stains with Prussian blue.The...

Question 21

The presence of schistocytes in the peripheral blood indicates which of the following processes?&#10;A)iron deficiency anemia&#10;B)intravascular hemolysis&#10;C)megaloblastic anemia&#10;D)extravascular hemolysis

Accepted Answer

The answer of The presence of schistocytes in the peripheral...

Deck 23: Introduction to Increased Destruction of Erythrocytes