Advanced Hematology Exam #6

Which of the following anemias is characterized by a normal bilirubin and haptoglobin, a transient thrombocytopenia, a leukocytosis, and a shift reticulocytosis? A. Acute posthemorrhagic anemia B. Cold hemagglutinin disease C. Nocturnal hemoglobinuria D. Chronic posthemorrhagic anemia

Acute posthemorrhagic anemia

A deficiency in glucose-6-phosphodehydrogenase (G-6-PD) is associated with all of the following, EXCEPT: A. A lack of NADP and glutathione reduction B. Two genetic isoenzyme variants C. A positive ascorbate cyanide test D. Autosomal inheritance

Autosomal inheritance

Vitamin B12 plays an important role in relationship to DNA synthesis by the: A. Conversion of deoxyuridine to thymidine B. Conversion of vitamin B6 to 5-methyl-tetra-hydrofolate (THF) C. Conversion of Guanine to Thymidine D. Conversion of 5-methyl-THF to THF by the conversion of homocystine to methionine

Conversion of 5-methyl-THF to THF by the conversion of homocystine to methionine

Anemia of blood loss in general can result in all of the following possible lab results, EXCEPT: A. Decreased serum haptoglobin B. Leukocytosis with a shift to the left C. A normocytic/normochromic anemia D. A microcytic/hypochromic anemia

Decreased serum haptoglobin

Which of the following conditions listed below, is a "conditioned" B12 deficiency that is due to a lack of intrinsic factor acquired secondarily to a surgical procedure? A. Autoantibodies to parietal cells B. Gastrectomy C. Autoantibodies to the IF-B12 complex D. Bowel resection

Gastrectomy

A chronic moderate normocytic/normochromic anemia presents with splenomegaly,1+ spherocytes, a decreased osmotic fragility, and an abnormal hemolysis test. Which of the following disorders best fits this description? A. Hereditary pyropoikilocyosis B. Hereditary Spherocytosis C. Hereditary Eliptocytosis D. Autoimmune hemolytic anemia

Hereditary Eliptocytosis

A 31-year-old black male was diagnosed with a severe hemolytic anemia. Medical history revealed a family history of anemia. His hematological work-up was characterized by a low H&H, a MCV of 62 fL, and marked poikilocytosis and schizocytosis. Further investigative testing demonstrated that the patient's RBCs fragmented at lower temperature-increases than normal RBCs. The most likely diagnosis for this patient is: A. Hgb-SS B. Paroxysmal Nocturnal Hemoglobinuria (PNH) C. Hereditary Pyropoikilocytosis (HPP) D. B12-deficiency anemia

Hereditary Pyropoikilocytosis (HPP)

A 57 year-old female was diagnosed to be anemic 25 years ago. At age 34 she developed jaundice after the birth of her first child. Years later she again developed jaundice after taking antibiotics for an upper-respiratory infection. Two years after that she again became jaundiced with a viral infection. She has 2 daughters who are also anemic with intermittent jaundice. Presently at age 57 she is being again evaluated for arthritis and her chronic anemia. Based upon the patient's medical history and her most current laboratory data below, this patient is a classic case of: A. Anemia of chronic liver disease B. Paroxysmal nocturnal hemoglobinuria C. Hereditary Spherocytosis D. Aplastic Anemia

Hereditary Spherocytosis

An increased osmotic fragility and an abnormal autohemolysis test would suggest the following anemia: A. Hereditary Spherocytosis B. Hemoglobin-C disease C. Fanconi's anemia D. beta-Thalassemia major

Hereditary Spherocytosis

All of the following disorders would present as positive for Heinz bodies, EXCEPT: A. G-6PD deficiency B. Anemia of unstable hemoglobin C. alpha o - Thalassemia D. Hgb-CC disease

Hgb-CC disease

Characteristic hematological findings of a hemolytic disorder include all of the following, EXCEPT: A. Shift reticulocytosis with polychromasia B. Leukocytosis with a shift to the left C. Decreased serum haptoglobin D. Hypoplasia of the marrow

Hypoplasia of the marrow

All of the following anemias can be classified as hemolytic anemias, EXCEPT: A. Iron deficiency anemia B. Hereditary spherocytosis C. Paroxysmal Nocturnal Hemoglobinuria D. Sickle-cell anemia

Iron deficiency anemia

A moderate hemolytic anemia that can result from chronic hypertension and presenting with a very high RDW and moderate schizocytosis on the blood smear would be: A. Paroxysmal Cold Hemoglobinuria B. Microangiopathic Hemolytic Anemia C. Pyruvate Kinase deficiency D. Hemolytic Disease of the Newborn

Microangiopathic Hemolytic Anemia

Which of the following is a normocytic/normochromic anemia with marrow hyperplasia? A. Pernicious anemia B. Acute intermittent porphyria C. Microangiopathic hemolytic anemia D. Anemia of liver disease

Microangiopathic hemolytic anemia

A 25 year-old male presented a blood picture of a chronic microcytic/normochromic anemia. His lab results also demonstrated hematuria, an absolute neutropenia, and thrombocytopenia. His osmotic fragility test was normal but the sugar-water test and Ham's test was positive. Based on these results this patient likely has: A. A G-6-PD deficiency B. Paroxysmal Nocturnal Hemoglobinuria C. Iron deficiency anemia due to chronic blood loss D. Autoimmune Hemolytic Anemia

Paroxysmal Nocturnal Hemoglobinuria

Which of the following anemias has a positive direct antiglobulin test (DAT) at 22 o C? A. Hemolytic disease of the newborn B. Paroxysmal cold hemoglobinuria C. Microangiopathic hemolytic anemia D. G-6PD Deficiency

Paroxysmal cold hemoglobinuria

Which of the disorders below results in bone marrow ineffective hemopoietic maturation resulting in a pancytopenia? A. Anemia of Chronic disease B. Liver disease C. HGB-C D. Pernicious anemia

Pernicious anemia

Some hemolytic anemias are inherited, and some are acquired. The genetically inherited hemolytic anemia would be which of the following? A. Pyruvate Kinase deficiency B. Paroxysmal Nocturnal Hemoglobinuria C. Acute Posthemorrhagic Anemia D. Cold Hemagglutinin disease

Pyruvate Kinase deficiency

All of the following are vital functions of glutathione (GSH) oxidation/reduction in the Phosphogluconate Pathway, EXCEPT: A. GSH is an important to eliminate the buildup of intracellular oxidants such as hydrogen peroxide B. The pathway functions to preserve vital RBC enzymes and the oxyhemoglobin form of hemoglobin C. Results in the two ATP molecules being produced for every one molecule of NADPH being changed to NADP D. The pathway is important in the conversion of small amounts of Hgb-M (methemoglobin) back to Hgb-A

Results in the two ATP molecules being produced for every one molecule of NADPH being changed to NADP

A hemolytic anemia can become macrocytic if accompanied by: A. Shift reticulocytosis B. Sickle cells C. Spherocytes D. Eliptocytes

Shift reticulocytosis

A 57 year-old female was diagnosed to be anemic 25 years ago. At age 34 she developed jaundice after the birth of her first child. Years later she again developed jaundice after taking antibiotics for an upper-respiratory infection. Two years after that she again became jaundiced with a viral infection. She has 2 daughters who are also anemic with intermittent jaundice. Presently at age 57 she is being again evaluated for arthritis and her chronic anemia. The technologist when examining this patient's (Question 2) blood smear, reported 2+ microcytes. The hemogram from the coulter cell counter, however, indicated A MCV of 98 fL. The best explanation for these conflicting results would be: A. The patient is also B12 deficient B. The technologist needs to go back to school. C. Shift reticulocytosis, and the presence of spherocytes D. The microcytes produce an artificially low Hct value which would by calculation, falsely increase the MCV. E. The increased bilirubin and decreased haptoglobin found in this patient is common with complicating liver problems, which would produce a large population of target cells and hence, a higher MCV

Shift reticulocytosis, and the presence of spherocytes

Autoimmune hemolytic anemia is best characterized by which of the following? A. Rouleaux formation B. Spherocytes C. Stomatocytes D. Helmet cells

Spherocytes

Paroxysmal nocturnal hemoglobinuria is a disorder of chronic intravascular hemolysis because: A. An autoantibody is produced against the red cell's Rh surface antigens B. The RBCs are rendered hypersensitive to complement C3 binding C. There is an abnormal beta-globin amino acid substitution resulting in hemoglobin precipitation and premature hemolysis D. There is an inherited glucose-6-phosphate dehydrogenase deficiency.

The RBCs are rendered hypersensitive to complement C3 binding

The Fluorescent Spot Test for a G-6PD deficiency is based on the principle of: A. The oxidation of NADP to NADPH which will fluoresce B. The loss of fluorescence when NADH is reduced to NAD C. Precipitated alpha-1, beta-1 dimers fluoresce D. The production of fluorescent Hgb-M in the absence of G-6PD

The oxidation of NADP to NADPH which will fluoresce

Genetic G-6PD deficiency presents with 2 genetic isoenzyme variations. Blacks that have a G- 6PD deficiency most commonly have the isoenzyme variant (Type-A; Type-B) and present with clinical symptoms of a (mild to moderate; severe) hemolytic anemia when challenged by antioxidants. A. Type-A; mild to moderate B. Type-B; severe C. Type-B; mild to moderate D. Type-A; severe

Type-A; mild to moderate