Chapter 29

Which medications are associated with an intermediate increase in a person's risk for developing aplastic anemia?

Chloramphenicol (Chloromycetin) Phenytoin (Dilantin) Trimethoprim-sulfamethoxazole (Bactrim) Chloramphenicol (Chloromycetin), phenytoin (Dilantin), and trimethoprim-sulfamethoxazole (Bactrim) are associated with an intermediate increase in the risk of developing aplastic anemia. The other options are not associated with a rare increase in risk.

What is the most common cause of iron deficiency anemia (IDA)?

Chronic blood loss The most common cause of IDA in well-developed countries is pregnancy and chronic blood loss.

The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of the following?

Myelin degeneration in the spinal cord Effects on the nervous system can occur if a vitamin B12 deficiency causes the anemia. Myelin degeneration may occur with the resultant loss of fibers in the spinal cord, producing paresthesia (numbness), gait disturbances, extreme weakness, spasticity, and reflex abnormalities. This selection is the only option that accurately describes the cause of paresthesia in such anemias.

Aplastic anemia

Normocytic-normochromic anemia Normocytic-normochromic anemias, including aplastic anemia, are characterized by erythrocytes that are relatively normal in size but with hemoglobin content that is insufficient in number.

After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result?

Pernicious From the options available, only pernicious anemia is caused by vitamin B12 deficiency, which is often associated with the end-stage type A chronic atrophic gastritis.

Which of the following is classified as a megaloblastic anemia?

Pernicious Pernicious anemia is the most common type of megaloblastic anemia. The remaining options are not classified as megaloblastic anemias.

The underlying disorder of which anemia is a result of the defective secretion of the intrinsic factor, which is essential for the absorption of vitamin B12?

Pernicious Vitamin B12 deficiency causes pernicious anemia, the most common type of megaloblastic anemia.

Considering sideroblastic anemia, what would be the expected effect on the plasma iron levels?

Plasma iron levels would be high. Plasma iron levels would be high (see Table 28-3).

How is the effectiveness of vitamin B12 therapy measured?

Reticulocyte count The effectiveness of cobalamin replacement therapy is determined by a rising reticulocyte count. The other options are not used as indicators of the effectiveness of vitamin B12 therapy

Which diseases are commonly associated with anemia of chronic disease?

Rheumatoid arthritis Acquired immunodeficiency syndrome (AIDS) Systemic lupus erythematosus Chronic hepatitis AIDS, rheumatoid arthritis, systemic lupus erythematosus, malaria, acute and chronic hepatitis, and chronic renal failure are commonly associated with anemias of chronic disease. Polycythemia vera is not associated with this form of anemia.

Which statement is true regarding warm autoimmune hemolytic anemia?

Erythrocytes are bound to macrophages and sequestered in the spleen. The immunoglobulin G-coated red blood cells bind to the Fc receptors on monocytes and splenic macrophages and are removed by phagocytosis. The other options are not true when considering this type of anemia.

What are the clinical manifestations of folate deficiency anemia?

Flatulence Dysphagia Stomatitis Cheilosis Specific symptoms of folate deficiency anemia include severe cheilosis (scales and fissures of the lips and corners of the mouth), stomatitis (inflammation of the mouth), and painful ulcerations of the buccal mucosa and tongue. Gastrointestinal symptoms may be present and include dysphagia (difficulty swallowing), flatulence, and watery diarrhea.

Which statement about folic acid is false?

Folic acid absorption is dependent on the enzyme folacin. Folic acid absorption is not dependent on the enzyme folacin. The other options are true statements regarding folic acid.

Which condition resulting from untreated pernicious anemia (PA) is fatal?

Heart failure Of the options available, untreated PA is fatal, usually because of heart failure.

When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice?

Heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. Jaundice (icterus) is present when heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. This selection is the only option that accurately describes the process that affects the occurrence of hemolytic anemia-related jaundice.

What is the fundamental physiologic manifestation of anemia?

Hypoxia The fundamental physiologic manifestation of anemia is a reduced oxygen-carrying capacity of the blood, resulting in tissue hypoxia.

What is the primary cause of the symptoms of polycythemia vera?

Increased blood viscosity As polycythemia vera progresses, many of the symptoms are related to the increased blood cellularity and viscosity. No other option is the primary cause of the symptoms of polycythemia vera.

Which of the following describes how the body compensates for anemia?

Increasing rate and depth of breathing Tissue hypoxia creates additional demands and compensatory actions on the pulmonary and hematologic systems. The rate and depth of breathing increase in an attempt to increase the availability of oxygen. This selection is the only option that accurately describes the compensation mechanism in such anemias.

Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails?

Iron deficiency Early symptoms of iron deficiency anemia (IDA) include fatigue, weakness, and shortness of breath. Pale earlobes, palms, and conjunctivae (see Figure 28-4) are also common signs. Progressive IDA causes more severe alterations, with structural and functional changes apparent in epithelial tissue (see Figure 28-4). The nails become brittle, thin, coarsely ridged, and spoon-shaped or concave (koilonychia) as a result of impaired capillary circulation. The tongue becomes red, sore, and painful. These symptoms are not associated with the other options.

Which anemia produces small, pale erythrocytes?

Iron deficiency The microcytic-hypochromic anemias, which include iron deficiency anemia (IDA), are characterized by erythrocytes that are abnormally small and contain abnormally reduced amounts of hemoglobin. This description is not true of the other options.

Pernicious anemia

Macrocytic-normochromic anemia Pernicious anemia, a form of macrocytic-normochromic anemia, is caused by vitamin B12 deficiency.

Sideroblastic anemia

Microcytic-hypochromic anemia The microcytic-hypochromic anemias include sideroblastic anemia.

Sideroblastic anemia can occasionally result from an autosomal recessive transmission inherited from which relative?

Mother An occasional autosomal recessive transmission occurs only with mitochondrial mutations from the mother.

Treatment for polycythemia vera involves which of the following?

Therapeutic phlebotomy and radioactive phosphorus In low-risk individuals, the recommended therapy is phlebotomy and low-dose aspirin, whereas radioactive phosphorus has been used to suppress erythropoiesis. The other options are not considered in the treatment of polycythemia vera.

What is the treatment of choice for pernicious anemia (PA)?

Vitamin B12 by injection Replacement of vitamin B12 (cobalamin) is the treatment of choice for PA. Initial injections of vitamin B12 are administered weekly until the deficiency is corrected, followed by monthly injections for the remainder of the individual's life. The other options are not treatments for PA.

Considering iron replacement therapy prescribed for iron deficiency anemia, who is likely to require long-term daily maintenance dosage?

A woman who has not yet experienced menopause Menstruating women may need daily oral iron replacement therapy (325 mg/day) until menopause as a result of their menstrual blood loss. None of the other options are a chronic source of blood loss.

Which statement best describes a Schilling test?

Administration of radioactive cobalamin and the measurement of its excretion in the urine to test for vitamin B12 deficiency The Schilling test indirectly evaluates vitamin B12 absorption by administering radioactive B12 and measuring excretion in the urine. This selection is the only option that accurately describes a Schilling test.

A 2000 ml blood loss will produce which assessment finding?

Air hunger Rapid thready pulse Cold clammy skin With a 2000 ml loss of blood, central venous pressure, cardiac output, and arterial blood pressure are below normal, even when at rest and in the supine position. The person commonly has air hunger; a rapid, thready pulse; and cold, clammy skin. With a 1500 ml loss of blood, supine blood pressure and pulse can still be normal. Lactic acidosis is observed with a blood loss of 2500 ml or more.

Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?

Anemia of chronic disease Anemia of chronic disease results from a combination of (1) decreased erythrocyte life span, (2) suppressed production of erythropoietin, (3) ineffective bone marrow erythroid progenitor response to erythropoietin, and (4) altered iron metabolism and iron sequestration in macrophages. This result is not true of the other options.

What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias?

Anisocytosis Additional descriptors of erythrocytes associated with some anemias include anisocytosis (assuming various sizes) or poikilocytosis (assuming various shapes) (see Figure 28-1). The remaining terms are not associated with this condition.

An allogenic bone marrow transplantation remains the preferred method for treating which anemia?

Aplastic Of the options available, bone marrow and, most recently, peripheral blood stem cell transplantation from a histocompatible sibling are the preferred treatments for the underlying bone marrow failure observed in aplastic anemias.

What is the most common pathophysiologic process that triggers aplastic anemia (AA)?

Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Tc cells appear to be the main culprits. None of the remaining options is considered a common trigger of AA.

Deficiencies in folate and vitamin B12 alter the synthesis of which of the following?

DNA Deficiencies in folate and vitamin B12 result in defective erythrocyte precursor DNA synthesis. These deficiencies are not associated with alterations of the other options.

Clinical manifestations of mild-to-moderate splenomegaly and hepatomegaly, bronze-colored skin, and cardiac dysrhythmias are indicative of which anemia?

Sideroblastic Of the options available, only sideroblastic anemia exhibits mild-to-moderate enlargement of the spleen (splenomegaly) and liver (hepatomegaly), as well as abnormal skin pigmentation (bronze colored). Heart rhythm disturbances, along with congestive heart failure, are major life-threatening complications related to cardiac iron overload.

In aplastic anemia (AA), pancytopenia develops as a result of which of the following?

Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes AA is a critical condition characterized by pancytopenia, which is a reduction or absence of all three blood cell types, resulting from the failure or suppression of bone marrow to produce adequate amounts of blood cells. This selection is the only option that accurately identifies the cause of pancytopenia.

Which statement is true regarding the physical manifestations of vitamin B12 deficiency anemia?

Symptoms are a result of demyelination. The neurologic manifestations characteristic of vitamin B12 deficiency anemia result from nerve demyelination that may produce neuronal death. These complications pose a serious threat because they are not reversible, even with appropriate treatment.

Continued therapy of pernicious anemia (PA) generally lasts how long?

The rest of one's life Because PA cannot be cured, maintenance therapy is a life-long endeavor.

What causes the atrophy of gastric mucosal cells that result in pernicious anemia?

Vitamin B12 malabsorption Deficiency in intrinsic factor (IF) secretion may be congenital or may result from adult onset gastric mucosal atrophy and the destruction of parietal cells. In older adults, virtually all vitamin B12-deficiency anemia is caused by a failure of IF-related absorption. This selection is the only option that accurately identifies the cause of gastric mucosal cell atrophy.

Which conditions are generally included in the symptoms of pernicious anemia (PA)?

Weakness Low hemoglobin Paresthesias Low hematocrit When the hemoglobin and hematocrit levels in the blood have significantly decreased, the individual experiences the classic symptoms of PA—weakness, fatigue, paresthesias of the feet and fingers, difficulty in walking, loss of appetite, abdominal pains, and weight loss.