Patho - Chapter 13: Disorders of Red Blood Cells

A registered nurse is teaching a student nurse about sickle cell anemia. Which statements made by the student nurse indicates effective learning? Select all that apply. "Sickle cell anemia can be detected in a blood sample screened for Hgb S." "Sickle cell anemia is a form of primary polycythemia." "Sickle cell anemia is a form of hemoglobinopathy." "Aplastic anemia results from sickle cell anemia." "Clients with sickle cell anemia inherited the disease."

- "Sickle cell anemia can be detected in a blood sample screened for Hgb S." - "Sickle cell anemia is a form of hemoglobinopathy." - "Clients with sickle cell anemia inherited the disease."

A patient has aplastic anemia with pancytopenia. Which of the following can the nurse expect? Select all that apply. Increased risk for infection Anemia Increased risk for bleeding Elevated hematocrit Polycythemia

- Increased risk for infection Rationale: Pancytopenia would imply a reduction in all blood cells, including WBCs - Anemia Rationale: Pancytopenia would imply a reduction in all blood cells, including RBCs - Increased risk for bleeding Rationale: Pancytopenia would imply a reduction in all blood cells, including thrombocytes Elevated Hct (NO) Hct would be reduced due to decreased RBCs Polycythemia (NO) indicated high RBC number

Which findings are consistent with folic acid deficiency anemia? Select all that apply. Low Hgb levels Elevated tHCy levels Folic acid levels lower than 4 ng/mL High Hct levels MCV high

- Low Hgb levels - Elevated tHCy levels - Folic acid levels lower than 4 ng/mL - MCV high Rationale: Hgb = low; Hct = low; MCV = high; MCH = normal; MCHC = normal; Folic acid levels = low; tHCy = high; MMA level = normal

Laboratory values reveal the following: hemoglobin of 19 grams per deciliter and hematocrit of 53%. Which of the following correctly interprets these values? Select all that apply. Red blood cell (RBC) loss is increased. Hemoglobin is normal while hematocrit is less than normal. Percentage of blood volume that is plasma is reduced. Anemia has developed. Both hemoglobin and hematocrit levels are elevated.

- Percentage of blood volume that is plasma is reduced. Rationale: if Hct is elevated, then plasma percentage is reduced. - Both hemoglobin and hematocrit levels are elevated. Rationale: both hemoglobin and hematocrit are higher than normal

Which of the following hematocrit values would be indicative of polycythemia?

60% Rationale: Hct values Males 45-52% Females 37-48%

A male patient is experiencing chronic renal failure and decreased synthesis of erythropoietin. Which of the following related to red blood cells may the nurse expect? A. Hematocrit of 45% B. Low red blood cell number C. Polycythemia D. Vitamin B12 deficiency anemia

B Rationale: EPO stimulates RBC formation. If EPO is lacking, then RBC formation will be reduced. A - Lack of EPO would cause lower-than-normal RBC level thus reducing Hct C - Polycythemia is an elevation in RBC levels. A lack of her EPO would cause reduced RBC numbers. D - Gastric problems resulting in reduced intrinsic factor to vitamin B12 deficiency anemia

In folic-acid deficiency, the laboratory clinician is looking for cells of which shape or color? A. Normocytic B. Megaloblastic C. Microcytic D. Hypochromic

B Rationale: Folic-acid deficiency results in larger-than-normal cells, which are referred to as megaloblastic. A - Folic-acid deficiency results in enlarged cells C - Microcytic would indicate smaller than normal cells. Folic-acid deficiency increases cell size D - Hypochromic cells occur with iron deficiency anemia not folic-acid deficiency anemia

A sickle cell anemia crisis leads to hemolysis of red blood cells (RBCs). Which of the following may the nurse expect to see? A. Decreased serum bilirubin B. Increased reticulate percentage C. Increased hematocrit D. Decreased likelihood of jaundice

B Rationale: Reticulocytes are immature RBCs, and levels will increase to replace lost cells A - Elevated hemolysis will increase bilirubin levels C - Elevated hemolysis decreases Hct levels D - Increased hemolysis increases the risk of jaundice formation

A woman believes that she has been diagnosed with anemia. Which lab value does not support this diagnosis? A. Hematocrit of 38% B. Hemoglobin levels of 18 grams per deciliter C. Red blood cell total count of 2.6 million per microliter D. The woman's hematocrit, hemoglobin, and red blood cell count support the diagnosis of anemia

B Rationale: This hemoglobin level is elevated and does not indicate anemia A - hct is low and would support anemia C - RBC count is low and supports anemia D - This is incorrect because Hct is low, but other values are normal

A patient has hemophilia. Which shows a correct understanding of this disease? A. Thalassemia is the result of folic acid deficiency. B. Thalassemia is also known as sickle cell anemia. shape. C. Thalassemia is a result of a genetic mutation. D. Thalassemia is commonly outgrown by adulthood.

C Rationale: Hemophilia can be an inherited disorder or arise from spontaneous mutation A - Thalassemia arises from a genetic defect B - Thalassemia and SCA are not the same condition D - Thalassemia is a lifelong condition

A patient's mother worries about a vaso-occlusive crisis for her son, who desires to play a team sport. Which of the following conditions does the son likely have? A. Polycythemia B. Hemophilia C. Sickle cell anemia D. Iron deficiency anemia

C Rationale: SCA alters shapre of RBCs, which can lodge in capillaries A - Polycythemia is an elevation in RBC levels B - Hemophilia is a condition that causes excessive bleeding D - Iron deficiency anemia does not cause vaso-occlusive crisis

A patient with sickle cell anemia, having been hospitalized with a vaso-occlusive crisis, is being discharged. Which instructions will be helpful for the patient? A. The number one recommendation is to increase your activity level. B. Do not overreact. Sickle cell anemia is not a severe disease and should not require hospitalization. C. Make certain you have adequate hydration and rest, and avoid stressors when possible. D. Use caution because your blood has limited ability to clot in a small cut may result in significant bleeding.

C Rationale: to reduce risk of vaso-occlusive crisis, pts should maintain adequate hydration, get adequate rest, and try to avoid stressors A - risk increased if activity level is increased beyond normal B - SCA, and vaso-occlusive seas, are severe medical conditions D - SCA and vso-occlusive crisis don't lead to significant bleeding issues

A female patient with chronic obstructive pulmonary disease (COPD) presents with a hematocrit value of 48%. What is the likely explanation? A. The patient has primary polycythemia. B. The patient has aplastic anemia. C. The decrease oxygenation of the blood associated with COPD has increased erythropoietin release. D. The COPD has caused dehydration, increasing hematocrit values.

C Rationale: increased EPO will increase RBC levels A - primary polycythemia is very rare, meaning it would be unlikely B - aplastic anemia reduces RBC levels D - COPD doesn't normally cause severe dehydration as to elevate RBC levels substantially

A trauma patient arrives in the emergency department with a stab wound. If a blood sample were to be looked at underneath the microscope, which type of anemia would likely be present? A. Megaloblastic B. Microcytic C. Sickle cell D. Normocytic

D Rationale: In anemia related to blood loss, cell size is not changed. A - Blood loss results in anemia with normal-sized cells, not enlarged cells B - Blood loss results in anemia with normal-sized cells, not smaller-than-normal cells C - Sickle cell is an inherited disorder

In iron deficiency anemia, which serum factor may be high? A. Serum iron B. Hematocrit C. Hemoglobin D. Total iron binding capacity

D Rationale: Increases when iron levels are low, indicating there is increased space available for iron to bind A - Serum ion would be low B - Hct levels will be low because RBCs cannot by synthesized at the normal level C - If iron is lacking, hemoglobin synthesis is decreased

Please place the steps in order which demonstrate how chronic obstructive pulmonary disease (COPD) can lead to secondary polycythemia. Decreased oxygen deliver to kidneys Bone-marrow stimulation Increased erythropoietin levels Decreased blood oxygen levels Pulmonary dysfunction

Pulmonary dysfunction Decreased blood oxygen levels Decreased oxygen deliver to kidneys Increased EPO levels Bone-marrow stimulation

Which of the following are hemoglobinopathies? Select all that apply. Primary polycythemia Sickle cell anemia Aplastic anemia Thalassemia Secondary polycythemia

Sickle cell anemia Thalassemia Rationale: Hemoglobinopathy is an inherited disorder of the Hgb molecule that can lead to destruction of RBCs. SCA and thalassemia are common hemoglobinopathies.

Which cell types are low in aplastic anemia? Select all that apply. osteocyte erythrocytes leukocytes thrombocytes hepatocytes

erythrocytes leukocytes thrombocytes Rationale: Aplastic anemia occurs when bone marrow fails resulting in hypocellular bone marrow and pancytopenia, which is a deficiency is all blood cells. Erythrocytes (RBC), leukoctyes (WBC), and thrombocytes (platelets) are different types of blood cells. Osteocytes are bone cells and hepatocytes are liver cells.