Question 1

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 that the patient has macrocytic anemia. One of the possible causes of macrocytic anemia during pregnancy is folate deficiency. Therefore, the most appropriate reflex test would be a folate assay to evaluate the patient's folate status. Iron studies and bilirubin levels are not relevant to the diagnosis of macrocytic anemia, and LDH levels are not specific for any particular type of anemia.

Question 2

A patient has hemolytic anemia.An instrument printout reveals a reticulocyte count of 8%,marked polychromasia and moderate schistocytes,and an MCV of 88 fl.What can be concluded about the bone marrow response to this hemolytic anemia?
A)It is adequate.
B)It is not adequate for the degree of hemolysis.
C)The reticulocyte count indicates that the marrow is responding at its maximum rate.
D)There is not enough information to determine whether bone marrow response is adequate.

Accepted Answer

B

Question 3

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), also known as a Coombs test, indicates the presence of antibodies or complement components bound to the surface of the patient's red blood cells. This can occur in autoimmune hemolytic anemia, in which the patient's immune system attacks their own red blood cells, leading to increased destruction of these cells. Thus, the correct answer is increased erythrocyte destruction (choice B) as a positive DAT is diagnostic for autoimmune hemolytic anemia.

Question 4

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

The answer of Which of the following laboratory tests could...

Question 5

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 result in the release of free hemoglobin into the circulation, which can be filtered into the urine and cause hemosiderinuria. Leukocytosis and a negative DAT are not typically associated with intravascular hemolysis, and a decreased reticulocyte count may indicate a bone marrow response to decreased RBC production or increased destruction in other compartments such as extravascular hemolysis.

Question 6

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 is indicative of increased reticulocytes in the peripheral blood, suggesting increased erythropoietic activity. Reticulocytes are immature red blood cells that still contain ribosomal RNA, giving them a bluish color when stained with certain dyes. The Reticulocyte Production Index (RPI) is a measure of erythropoietic activity and is calculated by dividing the patient's reticulocyte count by the normal reticulocyte maturation time (usually around 1 day). An increased RPI indicates a higher than normal rate of reticulocyte production and is often seen in conditions associated with increased red cell destruction or loss, such as hemolytic anemia or blood loss. Therefore, an increased RPI would best correlate with moderate polychromasia on the peripheral blood smear.

Question 7

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

Since the patient's hematocrit is lower than normal, there will be a dilutional effect on the reticulocyte count. To correct for this, we use the following formula: 
Corrected Retic Count = (Observed Retic %) x (Patient's Hct / Normal Hct)
Plugging in the given values, we get:
Corrected Retic Count = (5%) x (25% / 45%) = 2.78%

Question 8

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 9

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 destruction of red blood cells, which leads to the release of hemoglobin into the bloodstream.

Question 10

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. The classic signs of anemia include fatigue, pallor, and shortness of breath.

Question 11

A patient presents with a 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

A Reticulocyte Production Index (RPI) of >2 indicates an increased production of reticulocytes, which is typically seen in response to hemorrhage or hemolysis, where the bone marrow compensates for the loss of red blood cells.

Question 12

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 13

Which of the following clinical findings is associated with anemia:
A)Fatigue
B)Dyspnea
C)Skin pallor
D)All of the above

Accepted Answer

Anemia is a condition where there is a decrease in the number of red blood cells or hemoglobin, leading to a reduced capacity of blood to carry oxygen. This can cause symptoms such as fatigue, dyspnea (shortness of breath), and skin pallor (pale skin). Therefore, all of the above clinical findings are associated with anemia.

Question 14

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 most reliable method to measure RBC survival as it tracks the decay of the radioactive label in the RBCs over time. Conjugated bilirubin levels and urine hemoglobin can indicate hemolysis but do not give a direct measure of RBC survival. Reticulocyte count can indicate erythropoiesis but is not a direct measure of RBC survival.

Question 15

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 presents with microcytic anemia (MCV of 70 fl) and symptoms suggestive of iron deficiency anemia, such as fatigue and pallor. Iron studies are appropriate to confirm iron deficiency.

Question 16

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 defects are those that are inherent to the red blood cell itself, such as mutations in the genes that code for hemoglobin. Hb S is an example of an intrinsic erythrocyte defect, as it is a genetic mutation that results in the production of abnormal hemoglobin molecules, leading to sickle cell anemia. Antibody-coated RBCs, snake venom, and disseminated intravascular coagulation are all examples of extrinsic factors that can affect red blood cells.

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. Ferritin levels decrease in the early stages of iron deficiency before anemia develops. Other tests such as transferrin saturation and RDW may also be abnormal in iron-deficiency anemia, but they are not as specific as ferritin levels. Vitamin B12 assay is not relevant to iron-deficiency anemia, as it assesses B12 levels and does not indicate iron deficiency.

Question 18

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 refers to a situation where the body is able to compensate for the destruction of red blood cells, usually by increasing erythropoiesis (production of new red blood cells). Therefore, a patient with compensated hemolytic disease would likely have a normal or elevated hemoglobin level (as in choice D). A low RBC count (choice A) and low MCV (choice B) would suggest anemia, which is not consistent with compensated hemolytic disease. MCHC (choice C) refers to the concentration of hemoglobin in an individual red blood cell and a low MCHC would be seen in hypochromic anemias, which is not part of hemolytic disease.

Question 19

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 specific to evaluate hemolysis, whereas haptoglobin, hemopexin, and bilirubin are markers commonly used for the evaluation of hemolysis.

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 refers to an inherited abnormality of an erythrocyte, such as sickle cell anemia or hereditary spherocytosis.

Quiz 11: Introduction to Anemia

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

A patient has hemolytic anemia.An instrument printout reveals a reticulocyte count of 8%,marked polychromasia and moderate schistocytes,and an MCV of 88 fl.What can be concluded about the bone marrow response to this hemolytic anemia?

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

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 hemolysis?

All of the following are classic signs of anemia except:

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

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?

Which of the following clinical findings is associated with anemia:

Which of the following is best to measure RBC survival?

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:

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

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

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

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

Which of the following defines an intrinsic erythrocyte defect: