Deck 13: Hemolytic Anemias: Extracorpuscular Defects

Question 1

Alloimmune hemolytic anemia may result from:

A) Pregnancy
B) Blood transfusion
C) Organ transplant
D) All of the above
E) None of the above

Answer 1

All of the above

Question 2

Which of the following antibodies do not cause a delayed hemolytic transfusion reaction?

A) Anti-E
B) Anti-K
C) Anti-e
D) Anti-C
E) Anti-M

Answer 2

Anti-M

Question 3

An immune hemolytic disorder in which red cells of the fetus and newborn are destroyed by maternal IgG antibody is:

A) Warm autoimmune hemolytic anemia
B) Hemolytic disease of the newborn (HDN)
C) Hydrops fetalis
D) Hereditary persistence of fetal hemoglobin
E) Cold autoimmune hemolytic anemia

Answer 3

Hemolytic disease of the newborn (HDN)

Question 4

The alternate pathway may be triggered by:

A) Microorganisms
B) Polysaccharides
C) Lipopolysaccharides
D) All of the above
E) None of the above

Question 5

Which type of HDN is the most frequent?

A) Rh HDN
B) Duffy HDN
C) ABO HDN
D) Kidd HDN
E) Kell HDN

Question 6

In the case of partial phagocytosis, the red cell membrane reforms to form what type of red cell?

A) Target cell
B) Spherocyte
C) Schistocyte
D) Macrocyte
E) Drepanocyte

Question 7

In alloimmune hemolytic anemia, hemolysis results from:

A) Patient antibody to a foreign antigen coating the red cell
B) Patient antigen coating red cell
C) Patient antibody coating native red cell antigen
D) Drug in the patient serum coating red cells
E) None of the above

Question 8

Which of the following are classifications of immune hemolytic anemias?

A) Alloimmune
B) Autoimmune
C) Drug-induced
D) All of the above
E) None of the above

Question 9

Activation of the classical pathway is initiated by what immune complexes?

A) IgG or IgM
B) IgM or IgA
C) IgE or IgM
D) IgD or IgE
E) IgG or IgA

Question 10

The mechanism of direct lysis resulting from the release of lytic enzymes from effector cells that act on the red cell membrane is referred to as:

A) Antigen-dependent cellular cytotoxicity
B) Antibody-independent cellular cytotoxicity
C) Antibody-dependent cellular cytotoxicity
D) Antigen-independent cellular cytotoxicity
E) None of the above

Question 11

The spherocyte is indicative of:

A) Liver damage
B) Intravascular hemolysis
C) Extravascular hemolysis
D) Non-immune-mediated hemolysis
E) None of the above

Question 12

Complement is a group of serum proteins that interact with each other to bring about:

A) Complement-independent cell-mediated lysis
B) Complement-dependent cell-mediated lysis
C) Antibody-independent cell-mediated lysis
D) Extravascular hemolysis
E) None of the above

Question 13

Which clinical feature suggests an acute hemolytic transfusion reaction?

A) Fever
B) Chills
C) Hypotension
D) Nausea
E) All of the above

Question 14

Where does extravascular phagocytosis of red cells occur?

A) Spleen and liver
B) Liver and lymph nodes
C) Kidney and liver
D) Lungs and liver
E) Bone marrow and lymph nodes

Question 15

The main site of destruction for cells coated with complement alone is the __________.

A) Liver
B) Spleen
C) Kidney
D) Marrow
E) None of the above

Question 16

Which IgG subclass cannot activate complement in immune hemolysis?

A) IgG1
B) IgG2
C) IgG3
D) IgG4
E) IgG1 and IgG2

Question 17

What type of transfusion reaction would result from an incompatible mismatch in the ABO blood group?

A) Acute hemolytic
B) Hemolytic
C) Xenophobic
D) Delayed hemolytic
E) Allergic

Question 18

Which of the following clinical features suggests a delayed hemolytic transfusion reaction has occurred?

A) Mild fever
B) Mild jaundice
C) Unexpected fall in hemoglobin
D) All of the above
E) None of the above

Question 19

Anti-K was detected in a patient's serum 1 year ago in a routine antibody screen. This patient was transfused red cells containing antigen specific for anti-K. Forty-eight hours later the patient began exhibiting signs of a hemolytic anemia. What type of transfusion reaction is present?

A) Delayed
B) Acute
C) Immediate
D) Allergic
E) Febrile

Question 20

A patient received a blood transfusion that contained a foreign red cell antigen. The patient developed antibody to this foreign antigen. In this case a/an __________ response has occurred.

A) Alloimmune
B) Autoimmune
C) Drug-induced
D) Non-immune
E) Allergic

Question 21

Which drug mechanism functions by modifying the red cell membrane so that normal plasma proteins are absorbed non-immunologically?

A) Immune complex
B) Drug absorption
C) Membrane modification
D) Methyldopa-induced
E) Autoimmune

Question 22

A blood transfusion for a patient with cold agglutinin syndrome will require:

A) Irradiation
B) Transfusion with a warming coil
C) HbS negative
D) CMV negative
E) Washing of red cells

Question 23

Cold hemagglutinin disease represents __________ of all cases of autoimmune hemolytic anemia.

A) 70%
B) 16%
C) 2%
D) 12%
E) 50%

Question 24

In HDN, when extramedullary hematopoiesis takes over for the fetal bone marrow to compensate for increased red cell destruction, this results in:

A) A hypocellular bone marrow
B) Hepatosplenomegaly
C) Decrease in bilirubin
D) Aplastic anemia
E) Spherocytosis

Question 25

An autohemolysin can be defined as:

A) A warm autoantibody that binds a patient's red cells at low temperatures and fixes complement
B) A cold autoantibody that binds a patient's red cells at low temperatures and fixes complement
C) A cold autoantibody that binds a patient's red cells at warm temperatures and fixes complement
D) A cold autoantibody that binds a patient's red cells at low temperatures but does not fix complement
E) All of the above

Question 26

Laboratory features that suggest paroxysmal cold hemoglobinuria include:

A) Polychromasia
B) Poikilocytosis
C) Hemoglobinuria is present
D) Nucleated red blood cells
E) All of the above

Question 27

What pathological cold antibody disease is found in children in association with infectious mononucleosis, mumps, measles, and chicken pox?

A) Paroxysmal cold hemoglobinuria
B) Mycoplasma pneumoniae associated disease
C) Cold agglutinin syndrome
D) Secondary cold AIHA
E) Paroxysmal nocturnal hemoglobinuria

Question 28

In two-thirds of cases of warm autoimmune hemolytic anemia (WAIHA), the direct antiglobulin test (DAT) will result in reactivity with:

A) IgG only
B) IgG and C3d
C) C3d only
D) IgA
E) IgE

Question 29

Autoantibody in warm autoimmune hemolytic anemia (WAIHA) usually mimics __________ specifically.

A) Rh
B) Lewis
C) Duffy
D) Kell
E) Kidd

Question 30

Autoimmune hemolytic anemia represents an abnormality in which:

A) Hemolysis results from antigen sensitization through blood transfusion.
B) Self-recognition of an individual's own red cell antigens is lost.
C) Hemolysis results from patient's antibodies binding to blood groups other than ABO.
D) Hemolysis is always drug induced.
E) All of the above

Question 31

Warm autoimmune hemolytic anemia accounts for __________ of all cases of autoimmune hemolytic anemia.

A) 12%
B) 70%
C) 16%
D) 4%
E) 40%

Question 32

What pathological cold antibody disease occurs in persons older than 50 years of age and demonstrates acrocyanosis of the hands and feet and the presence of a lymphoproliferative disorder?

A) Paroxysmal cold hemoglobinuria
B) Mycoplasma pneumoniae associated disease
C) Cold agglutinin syndrome
D) Secondary cold AIHA
E) Paroxysmal nocturnal hemoglobinuria

Question 33

A Donath-Landsteiner test is performed to determine the presence of antibodies with biphasic activity. The results show no hemolysis in the control sample and hemolysis in the test sample. These test results should be reported as:

A) Positive
B) Negative
C) Inconclusive
D) Borderline
E) None of the above

Question 34

A unit of blood transfused to a WAIHA patient should be:

A) Least incompatible in the crossmatch
B) Negative for antigens for clinically significant antibodies present in the patient
C) Transfused slowly
D) Transfused in small volumes
E) All of the above

Question 35

Drug-induced immune hemolytic anemia represents ____ of autoimmune hemolytic anemias.

A) 16%
B) 12%
C) 70%
D) 2%
E) 40%

Question 36

On a peripheral blood smear of a newborn suspected of HDN, one morphological abnormality that would help distinguish ABO HDN from Rh HDN is:

A) Reticulocytosis
B) Leukocytosis
C) Spherocytes
D) Nucleated red cells
E) Target cells

Question 37

The peripheral blood smear of a patient with warm autoimmune hemolytic anemia will show:

A) Marked polychromasia
B) Reticulocytosis
C) Spherocytosis
D) Red cell fragmentation
E) All of the above

Question 38

A patient who has been taking quinidine presents with hemoglobinemia and hemoglobinuria. His DAT shows specificity with anti-complement reagents but not with anti-IgG. His eluate is nonreactive. Which drug mechanism is responsible?

A) Immune complex
B) Drug absorption
C) Membrane modification
D) Methyldopa-induced
E) Autoimmune

Question 39

Which drug is primarily associated with the drug absorption (hapten) mechanism?

A) Aldomet
B) Streptomycins
C) Penicillin
D) Acetaminophen
E) Primaquine

Question 40

What cold autoantibodies are found in the serum of normal, healthy individuals?

A) Anti-H
B) Anti-I
C) Anti-IH
D) All of the above
E) None of the above

Question 41

Plasmodium __________ has proven to be the most fatal of species of malaria presenting with massive intravascular hemolysis, jaundice, and hypotension.

A) vivax
B) ovale
C) malariae
D) falciparum
E) hemolytica

Question 42

The presence of these cells in the peripheral blood suggests that the patient is in the hemolytic phase of bartonellosis:

A) Spherocytes
B) Nucleated red cells
C) Acanthocytes
D) Schistocytes
E) Target cells

Question 43

Chemicals or drugs that induce oxidative stress in red cells may result in hemoglobin being denatured and the formation of which type of inclusion?

A) Hemoglobin H inclusions
B) Siderocytes
C) Howell-Jolly bodies
D) Heinz bodies
E) Pappenheimer bodies

Question 44

Evaluate the course of infection that can occur in a splenectomized patient with babesiosis:

A) Acute intravascular hemolysis
B) Hemoglobinemia
C) Renal failure
D) All of the above
E) None of the above

Question 45

What hemolytic anemia is a common occurrence in joggers and marathon runners?

A) Cardiac prosthesis
B) March hemoglobinuria
C) Hemolytic uremia syndrome
D) Thrombotic thrombocytopenic purpura
E) Idiopathic thrombocytopenic purpura

Question 46

To illustrate the presence of a malarial parasite in a blood smear, which stain is suggested?

A) Methylene blue
B) Giemsa
C) Prussian blue
D) Eosin
E) Crystal violet

Question 47

Intravascular hemolysis due to mechanical etiologies is usually accompanied by the presence of __________ on the peripheral blood smear.

A) Schistocytes
B) Target cells
C) Sickle cells
D) Ovalocytes
E) Spherocytes

Question 48

A drug mechanism that results in a positive DAT with IgG specificity and a reactive eluate that usually mimics anti-e specificity is:

A) Immune complex
B) Drug absorption
C) Membrane modification
D) Methyldopa-induced
E) Autoimmune

Question 49

Microangiopathic hemolytic anemia is usually characterized by the presence of:

A) Schistocytes
B) Increased platelets
C) Leukocytosis
D) Normocytes
E) Target cells

Question 50

Which is a characteristic red blood cell morphology in patients with abetalipoproteinemia?

A) Acanthocytes
B) Target cells
C) Spherocytes
D) Helmet cells
E) None of the above

Question 51

Laboratory findings that support a diagnosis of a malaria infection include:

A) Normochromic/normocytic anemia
B) Leukopenia
C) Thrombocytopenia
D) Presence of schizont on smear
E) All of the above