Deck 11: Introduction to Anemia

Question 1

A patient experiencing intravascular hemolysis would likely show which of the following:

A) Leukocytosis
B) Decreased reticulocyte count
C) Hemosiderinuria
D) Negative DAT

Answer 1

Hemosiderinuria

Question 2

Which of the following laboratory values would best correlate with moderate polychromasia on the peripheral blood smear?

A) Decreased bilirubin
B) Increased RPI
C) Schistocytes on the PB smear
D) Low PLT count

Answer 2

Increased RPI

Question 3

CBC results on a pregnant patient indicate an MCV of 112 fl. What would be the most appropriate reflex test?

A) Iron studies
B) Bilirubin
C) LDH
D) Folate assay

Answer 3

Folate assay

Question 4

A patient presents with an RPI of >2 and macrocytic morphology of the red blood cells. Which survival defect does this most likely represent?

A) B₁₂ deficiency
B) Folate deficiency
C) Hemorrhage or hemolysis
D) Myelodysplasia

Question 5

Which of the following clinical findings is associated with anemia?

A) Jaundice
B) Hepatomegaly
C) Splenomegaly
D) All of the above

Question 6

An increased IRF is not seen in which of the following?

A) Erythropoietin therapy
B) Iron therapy in iron deficient patients
C) Bone marrow recovery post-transplant
D) Aplastic anemia

Question 7

All of the following laboratory tests can be used for evaluation of hemolysis except:

A) Haptoglobin
B) Hemopexin
C) Total protein
D) Bilirubin

Question 8

Which of the following defines hemolysis?

A) The destruction of red cells resulting in the release of hemoglobin
B) The disorder characterized by a decrease in the normal concentration of hemoglobin or erythrocytes
C) The breakdown product of the heme portion of the hemoglobin molecule
D) The loss of a large amount of blood either internally or externally

Question 9

A patient experiencing compensated hemolytic disease would show which of the following lab results?

A) RBC count: 2.8 × 10¹²/L
B) MCV: 73 fL
C) MCHC: 28 g/dL
D) Hb 15.4 g/dL

Question 10

A patient with a bleeding problem is complaining to her physician about excessive fatigue. Physical examination reveals a thin, pale woman with pale mucosal membranes. Significant CBC findings include an MCV of 70 fl. Based on these findings, follow-up testing should be ordered for:

A) Iron studies
B) Vitamin B₁₂ and folate assays
C) Coagulation screening tests
D) A bone marrow aspirate

Question 11

All of the following are classic signs of anemia except:

A) Fatigue
B) Pallor
C) Shortness of breath
D) Nosebleeds

Question 12

Which of the following laboratory tests could be used to help identify the cause of an anemia?

A) Platelet count
B) Haptoglobin concentration
C) RBC count
D) Absolute lymphocyte count

Question 13

An instrument printout indicates that a patient has an RPI of 1.3, hemoglobin of 7 g/dL, and MCV of 112 fl. What can be concluded from this?

A) There is acute hemolysis present.
B) This is the result of iron deficiency.
C) The anemia is associated with renal disease.
D) There could be a nuclear maturation defect.

Question 14

The finding of a positive direct antiglobulin test (DAT) for a patient is likely to result in which of the following pathologies:

A) Increased bone marrow production of erythrocytes
B) Increased erythrocyte destruction
C) Decreased bone marrow production of erythrocytes
D) Liver disease

Question 15

Which of the following represents an example of an intrinsic erythrocyte defect?

A) Hb S
B) Antibody-coated RBCs
C) Snake venom
D) Disseminated intravascular coagulation

Question 16

Which of the following is best to measure RBC survival?

A) Using conjugated bilirubin
B) Using urine hemoglobin
C) Monitoring ⁵¹Cr labeled RBCs
D) Using reticulocyte count

Question 17

What test is the most sensitive and specific for detecting iron-deficiency anemia?

A) Vitamin B₁₂ assay
B) Ferritin
C) RDW
D) Transferrin saturation

Question 18

A patient sample had a retic count of 5%. The patient's hematocrit was 25%. Normal hematocrit is 45%. What is the corrected reticulocyte count?

A) 3.50%
B) 2.78%
C) 5%
D) 10%

Question 19

Normal hematocrit is 45%. What is the RPI for this patient with a reticulocyte count of 5% and hematocrit of 25%?

A) 2.39
B) 2.59
C) 1.39
D) 4.50

Question 20

Which of the following defines an intrinsic erythrocyte defect?

A) Erythrocytes that are damaged by chemical, mechanical, or physical agents
B) The agglutination of erythrocytes by antigen/antibody interactions
C) Inherited abnormalities of an erythrocyte
D) Destruction of red cells within the vasculature

Question 21

An apparent pancytopenia is noted in a patient's CBC results. A bone marrow aspirate is performed, and the M:E results are 2:1. Do these results make sense? Why or why not?

Question 22

How would you classify an anemic patient whose reticulocyte count is 0.5%?

A) Hypoproliferative
B) Extravascular hemolytic
C) Maturation defect
D) Survival defect

Question 23

Patient results indicate an RPI of 1.8 and an MCV of 109 fl. Do these results make sense? Why or why not?

Question 24

The peripheral blood smear of a patient with anemia reveals normocytic, normochromic RBCs and the RPI is <2. Which of the following is likely to be the cause of the anemia?

A) Thalassemia
B) Chronic inflammation
C) Sickle cell anemia
D) Porphyrias

Question 25

Blood flow adaptations to anemia are achieved by increasing the respiration rate and:

A) Increasing the circulation rate
B) Decreasing 2,3-BPG
C) Decreasing cardiac output
D) Increasing blood viscosity

Question 26

A 34-year-old woman has severe anemia. She complains of a feeling of fullness and splenomegaly. This diagnosis and clinical symptoms indicate:

A) a chronic hemolytic process
B) an acute hemolytic anemia
C) intravascular hemolysis
D) extravascular hemolysis

Question 27

Which of the following poikilocytes would be associated with a hemolytic anemia?

A) Oval macrocytes
B) Echinocytes
C) Dacryocytes
D) Spherocytes

Question 28

A patient sample had a retic count of 5% and hematocrit of 25%. Normal hematocrit is 45%. How would a bone marrow evaluation help you determine whether the bone marrow is responding to the pancytopenia?

Question 29

Which of the following pathologic conditions would produce an anemia with anisocytosis?

A) Aplastic anemia
B) Acute hemorrhage
C) Chronic leukemia
D) Immune hemolytic anemia

Question 30

A bone marrow examination was ordered on a patient with a 6.8 g/dL hemoglobin. The examination revealed an increase in fibrous tissue. This is an indication that the anemia is likely the result of a:

A) Proliferation defect
B) Nuclear maturation defect
C) Survival defect
D) Cytoplasmic maturation defect

Question 31

Which laboratory test provides early and sensitive indication for the diagnosis of a hemolytic disease?

A) MCV
B) Bilirubin
C) Serum lactate dehydrogenase
D) Haptoglobin

Question 32

Explain how the sensitivity and specificity of a laboratory test can be used to screen and confirm a differential diagnosis of anemia.

Question 33

A blood sample has moderate spherocytes, schistocytes, and polychromasia on the smear. What would you expect the results of the following to be?
a. Bilirubin
b. LDH
c. Hemoglobin
d. Retic count
e. Haptoglobin

Question 34

Microcytic hypochromic anemias are associated with which functional abnormality?

A) Defective folate utilization
B) Bone marrow hypoplasia
C) Fibrotic bone marrow
D) Defective hemoglobin synthesis