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

Accepted Answer

Intravascular hemolysis can lead to the presence of free hemoglobin in the urine, which can appear as hemosiderinuria. Leukocytosis and decreased reticulocyte count are not typical findings in intravascular hemolysis. A negative direct antiglobulin test (DAT) may occur in some cases, but it is not a defining feature.

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

Accepted Answer

Polychromasia refers to the presence of immature red blood cells in the blood, which can occur in response to increased red blood cell production or increased destruction of mature red blood cells. The reticulocyte production index (RPI) measures the percentage of immature red blood cells (reticulocytes) in the blood, and an increased RPI would indicate an increase in red blood cell production and support the presence of polychromasia on the peripheral blood smear. Decreased bilirubin levels and low platelet counts do not directly correlate with polychromasia, and the presence of schistocytes on the peripheral blood smear would suggest an alternative diagnosis such as hemolytic anemia.

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

Accepted Answer

An MCV of 112 fl indicates macrocytic anemia, which is commonly associated with folate deficiency during pregnancy. Therefore, the most appropriate reflex test would be a folate assay. Iron studies, bilirubin, and LDH would not provide relevant information in this scenario.

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

Accepted Answer

An RPI (Reticulocyte Production Index) of >2 indicates increased red blood cell production, typically seen in response to hemorrhage or hemolysis, not in B12 or folate deficiency, which are associated with ineffective erythropoiesis.

Question 5

Which of the following clinical findings is associated with anemia?
A) Jaundice
B) Hepatomegaly
C) Splenomegaly
D) All of the above

Accepted Answer

All of the options listed can be associated with anemia. Jaundice can occur in hemolytic anemias due to increased breakdown of red blood cells. Hepatomegaly and splenomegaly can occur as the liver and spleen work to remove damaged or aged red blood cells from circulation or in conditions that cause extramedullary hematopoiesis.

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

Accepted Answer

An increased IRF (reticulocyte count) is not seen in aplastic anemia, as the bone marrow is not producing enough red blood cells. In contrast, erythropoietin therapy, iron therapy in iron-deficient patients, and bone marrow recovery post-transplant can all increase IRF.

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

Accepted Answer

Total protein is not a specific laboratory test for evaluation of hemolysis. Haptoglobin, hemopexin, and bilirubin are all indicators of hemolysis.

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

Accepted Answer

Hemolysis is the process of destruction of red blood cells, and the release of hemoglobin follows.

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

Accepted Answer

Compensated hemolytic disease means that the body is able to compensate for the destruction of red blood cells by producing more, so the Hb levels would be normal or high, as in this case where Hb is 15.4 g/dL. A low RBC count (choice A) and low MCV (choice B) and MCHC (choice C) indicate anemia, which is not consistent with compensated hemolytic disease.

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

Accepted Answer

The patient's symptoms and CBC findings suggest iron deficiency anemia, characterized by microcytic anemia (MCV of 70 fl, indicating small red blood cells). Iron studies are the appropriate follow-up tests to confirm this diagnosis.

Question 11

All of the following are classic signs of anemia except:
A) Fatigue
B) Pallor
C) Shortness of breath
D) Nosebleeds

Accepted Answer

Nosebleeds are not a classic sign of anemia. Fatigue, pallor, and shortness of breath are commonly associated with anemia.

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

Accepted Answer

Haptoglobin concentration can help identify hemolytic anemia, as low levels may indicate increased red blood cell destruction.

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.

Accepted Answer

The RPI (reticulocyte production index) of 1.3 suggests inadequate bone marrow response for the degree of anemia (hemoglobin of 7 g/dL), and an MCV (mean corpuscular volume) of 112 fl indicates macrocytosis. These findings are consistent with a nuclear maturation defect, such as megaloblastic anemia, which can be caused by vitamin B12 or folate deficiency.

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

Accepted Answer

A positive direct antiglobulin test (DAT) indicates the presence of antibodies and/or complement bound to the surface of red blood cells. This suggests that the patient is experiencing increased erythrocyte destruction, also known as hemolysis. Therefore, option B is the correct answer.

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

Accepted Answer

Intrinsic erythrocyte defect refers to a defect within the RBC itself. Hb S is an abnormal hemoglobin variant that is inherited and results in sickle cell disease, which is a type of intrinsic erythrocyte defect. Antibody-coated RBCs are a result of an immune response and external factor, making it an extrinsic factor. Snake venom is also an external factor, and disseminated intravascular coagulation is a systemic disorder affecting multiple components of the coagulation pathway, not just RBCs.

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

Accepted Answer

Monitoring ⁵¹Cr labeled RBCs is the best option as it involves labeling the RBCs with a radioactive isotope and tracking their survival over time using nuclear medicine imaging techniques. This is a direct way to measure RBC survival and is considered the gold standard method. The other options, such as measuring conjugated bilirubin, urine hemoglobin, or reticulocyte count, can provide indirect information about RBC survival but are not as precise or accurate.

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

Accepted Answer

Ferritin is the most sensitive and specific test for detecting iron-deficiency anemia. It measures the body's iron stores, and levels will be decreased in cases of iron-deficiency anemia. The other options may be abnormal in iron-deficiency anemia, but they are not as specific or sensitive as ferritin.

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%

Accepted Answer

To calculate the corrected reticulocyte count, we need to adjust for the patient's hematocrit. The formula for corrected reticulocyte count is:
% corrected reticulocytes = observed reticulocyte count x (patient's hematocrit / normal hematocrit)

Plugging in the numbers:
% corrected reticulocytes = 5% x (25% / 45%)
% corrected reticulocytes = 2.78% (rounded to two decimal places)

Therefore, the correct answer is choice B.

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

Accepted Answer

The Reticulocyte Production Index (RPI) is calculated to adjust the reticulocyte count for the degree of anemia and is given by the formula: (Reticulocyte count % × Patient's hematocrit / Normal hematocrit) / Maturation correction factor. For a hematocrit of 25%, the maturation correction factor is approximately 2. Therefore, RPI = (5% × 25%) / (45% × 2) = 1.39.

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

Accepted Answer

An intrinsic erythrocyte defect is one that is inherited, meaning it is a genetic abnormality of the erythrocyte. Examples include sickle cell anemia, thalassemia, and hereditary spherocytosis.

Quiz 11: Introduction to Anemia

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

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

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

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

Which of the following clinical findings is associated with anemia?

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

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

Which of the following defines hemolysis?

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

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:

All of the following are classic signs of anemia except:

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

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?

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

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

Which of the following is best to measure RBC survival?

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

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?

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

Which of the following defines an intrinsic erythrocyte defect?