Module 12: Alterations of Erythrocyte Function

Toxic causes of aplastic anemia include which of the following? A) Drugs B) Industrial toxins C) Radiation exposure D) All of the above

D) All of the above

A 28-year-old woman with a history of rheumatoid arthritis is seen in a prenatal clinic for the first time late in her second trimester of pregnancy. She reports severe fatigue and experiences shortness of breath when going up stairs. Laboratory evaluation reveals low hematocrit and hemoglobin levels. Which of the following is a (are) potential cause(s) of her anemia? A) Anemia of chronic inflammation B) Iron deficiency C) Folate deficiency D) All of the above

D) All of the above Answer Feedback: Rheumatoid arthritis is associated with anemia of chronic inflammation; however, pregnancy is a risk factor for both iron-deficiency and folate-deficiency anemia, since demand for both nutrients is elevated.

What is the pattern of inheritance of the gene for sickle cell disease? A) Autosomal dominant B) Nondisjunction C) X-linked recessive D) Autosomal recessive

D) Autosomal recessive

What is the general cause of aplastic anemia? A) Hemolysis in the spleen B) Severe nutritional deficiencies C) Autoimmune destruction of mature red blood cells D) Bone marrow failure

D) Bone marrow failure

In evaluating for iron deficiency, which of the following lab tests provides the most accurate assessment of iron stores in the tissues? A) Hemoglobin B) Serum iron C) MCV D) Serum ferritin

D) Serum ferritin

All of the following are reasons why chronic infections (HIV disease, hepatitis), rheumatological diseases, and malignancies result in anemia of chronic inflammation (anemia of chronic disease), except: A) decreased erythropoiesis. B) disordered iron utilization by developing erythrocytes. C) decreased erythrocyte survival. D) all of the above.

D) all of the above.

Anemia from recent blood loss (acute blood loss) usually exhibits a red blood cell morphology that is: A) macrocytic and normochromic. B) microcytic and hypochromic. C) macrocytic and hypochromic. D) normocytic and normochromic

D) normocytic and normochromic Answer Feedback: Loss of whole blood results in anemia; however, the remaining erythrocytes, while fewer in number, are morphologically normal. Over time, if the blood loss were significant, the bone marrow might not have adequate iron stores to maintain normal erythropoiesis, and an iron-deficiency anemia might develop.

Clinical manifestations unique to vitamin B12 anemia (i.e., usually absent in other types of anemia) include: A) fatigue, dyspnea on exertion, and pale skin. B) palpitations, chest pain, and signs of heart failure. C) dizziness, headaches, and nausea. D) paresthesias, muscle weakness, and ataxia.

D) paresthesias, muscle weakness, and ataxia.` Answer Feedback: Neurological complications caused by vitamin B12 deficiency include paresthesias, muscle weakness, and ataxia. These symptoms are related to demyelination of peripheral neurons.

Pernicious anemia is caused by: A) iron deficiency. B) bone marrow failure. C) folate deficiency. D) vitamin B12 deficiency.

D) vitamin B12 deficiency. Answer Feedback: Vitamin B12 deficiency causes a severe anemia called pernicious anemia. In Latin 'pernicious' means 'highly injurious.'

In the United States, sickle cell disease is most common among _________ populations. A) Hispanic/Latino B) Asian C) Black D) Caucasian

C) Black Answer Feedback: Sickle cell disease occurs most frequently in blacks. The sickle cell trait provides protection against malaria and therefore is most commonly found in individuals with origins in equatorial regions.

In anemia, which of the following is a physiologic response to hypoxia? A) Low blood pressure B) Splenomegaly C) Increased respiratory rate D) Clot formation

C) Increased respiratory rate

In addition to a low serum hemoglobin and hematocrit, which of the following problems also manifest with aplastic anemia? A) Elevated bilirubin levels B) Formation of deep vein thromboses C) Increased risk of acquiring serious infections D) All of the above

C) Increased risk of acquiring serious infections Answer Feedback: Bone marrow failure in aplastic anemia causes leukopenia and immunosuppression, which increases susceptibility to infection.

An increase in which of the following laboratory values would indicate the presence of a hemorrhagic or hemolytic anemia? A) Hematocrit B) MCV C) Reticulocyte count D) All of the above

C) Reticulocyte count

Which of the following problems is not a known cause of iron deficiency? A) Blood loss B) Inadequate dietary iron C) Severe diarrhea D) Disorders of iron metabolism

C) Severe diarrhea

Iron-deficiency anemia among adult populations in the United States is most commonly caused by: A) chronic inflammatory and autoimmune diseases. B) inadequate dietary iron. C) chronic gastrointestinal bleeding. D) renal disease.

C) chronic gastrointestinal bleeding. Answer Feedback: Iron-deficiency anemia among adult populations in the United States is usually caused by blood loss such as with chronic gastrointestinal bleeding.

General causes of the decreased number of erythrocytes in anemia include all of the following except: A) hemorrhage. B) hemolysis. C) dehydration. D) decreased erythropoiesis.

C) dehydration.

Which of the following is the underlying pathophysiologic mechanism leading to autoimmune hemolytic anemia? Answers: A) Antigen-antibody reaction B) Hemolysis under hypoxic conditions C) IgA destruction of red blood cells D) Splenic destruction of red blood cells

A) Antigen-antibody reaction Answer Feedback: Autoimmune hemolytic anemias are caused by an antibody-antigen reaction on the surface of red blood cells.

Which of the following blood tests allows the clinician to visualize structural changes in the erythrocytes such as sickle cells or schistocytes? A) Blood smear B) MCV C) Mean corpuscular hemoglobin (MCH) D) Hematocrit

A) Blood smear

Vaso-occlusive crisis in sickle cell disease manifests with which of the following symptoms? Answers: A) Pain B) Pancytopenia C) Splenomegaly D)Hypotension

A) Pain Answer Feedback: Ischemia from the obstruction of capillaries by malformed erythrocytes results in pain.

Vaso-occlusive crisis in sickle cell disease manifests with which of the following symptoms? A) Pain B) Pancytopenia C) Splenomegaly D) Hypotension

A) Pain Answer Feedback: Ischemia from the obstruction of capillaries by malformed erythrocytes results in pain.

Clinical manifestations of iron deficiency include all of the following except: A) diarrhea. B) fatigue and weakness. C) brittle, concave nails. D) a red, sore tongue.

A) diarrhea. Answer Feedback: Iron losses in the stool are constant, even with diarrhea.

A unique manifestation of hemolytic anemia (i.e., generally absent in other forms) is: A) jaundice. B) paralysis. C) cerebral edema. D) cyanosis.

A) jaundice.

Iron deficiency anemia usually exhibits a red blood cell morphology that is: A) microcytic and hypochromic. B) macrocytic and normochromic. C) normocytic and normochromic. D) macrocytic and hypochromic.

A) microcytic and hypochromic. Answer Feedback: Iron deficiency anemia usually exhibits a red blood cell morphology that is microcytic and hypochromic. Low hemoglobin content in the erythrocyte results in smaller cell volumes.

Which of the following population groups are at the highest risk for developing a folate deficiency anemia? A) Children born with a congenital intrinsic factor deficiency B) Alcoholics C) Menstruating women D) Vegetarians

B) Alcoholics Answer Feedback: Alcoholics are at high risk for folate deficiency anemia due to malnutrition and impairment of folate metabolism.

Which of the following statements provides the best general definition of anemia? A) Decreased amount of circulating plasma volume B) Decreased oxygen-carrying capacity of the blood cells C) Presence of tissue hypoxia D) Bone marrow failure

B) Decreased oxygen-carrying capacity of the blood cells

Which of the following lab test results would one expect to find in long-standing iron deficiency anemia? Answers: A) Normal hemoglobin B) Decreased serum iron C) Increased MCV D) Increased serum ferritin

B) Decreased serum iron Answer Feedback: Serum iron will drop when iron in the tissues is totally depleted, which occurs in long standing anemia.

Which of the following blood tests measures the percentage of erythrocytes in a given volume of blood? A) Hemoglobin B) Hematocrit C) Mean cell volume (MCV) D) Red blood cell count

B) Hematocrit Answer Feedback: The hematocrit is the percentage of erythrocytes in a given volume of plasma and is useful for determining whether anemia is present.

Which of the following descriptions is characteristic of sickle cell disease? A) Malformed, sickle-shaped platelets lead to thrombocytopenia and bleeding. B) Hemoglobin reacts to deoxygenation or dehydration by sickling the erythrocytes. C) Sickled erythroblasts are unable to form adequate amounts of hemoglobin. D) Production of antibodies that attach to erythrocytes, causing sickling.

B) Hemoglobin reacts to deoxygenation or dehydration by sickling the erythrocytes.

Which of the following problems is usually present in sideroblastic anemia? Answers: A) Central nervous system demyelination B) Increased serum iron and iron toxicity C) Gastric atrophy D) Immunosuppression

B) Increased serum iron and iron toxicity Answer Feedback: Since in sideroblastic anemia there is adequate iron, but the bone marrow fails to incorporate it into the hemoglobin, elevated serum iron and iron toxicity often result.

Why is gastric bypass surgery for morbid obesity a risk factor for the development of pernicious (vitamin B12 deficiency) anemia? A) Vitamin B12 is absorbed in the stomach. B) Intrinsic factor production by the gastric epithelium is reduced. C) Postoperative antibodies to vitamin B12 are produced. D) Vitamin B12 stores are in the adipose tissue.

B) Intrinsic factor production by the gastric epithelium is reduced.

In anemia, what factor stimulates the production of erythropoietin? A) Low blood viscosity B) Tissue hypoxia C) Inflammation D) Release of stress hormones

B) Tissue hypoxia Answer Feedback: Hypoxemia caused by the decreased oxygen-carrying capacity of erythrocytes in anemia stimulates the production of erythropoietin.

The most common cause of acquired hemolytic anemia is: A) viral infection of erythrocytes. B) autoimmune destruction of erythrocytes. C) severe nutritional deficiencies. D) alcoholism.

B) autoimmune destruction of erythrocytes. Answer Feedback: The most common cause of acquired hemolytic anemia is immune destruction of erythrocytes, including autoimmune, allergic and drug induced.

The reticulocyte count in iron deficiency, vitamin B12, and folate deficiency is: A) increased. B) decreased. C) absent. D) impossible to measure.

B) decreased Answer Feedback: Any nutrient deficiency anemia results in the decreased bone marrow production of erythrocytes and therefore is reflected in a decreased reticulocyte count.

Immediate, life-threatening consequences of a massive hemorrhage are primarily related to: A) loss of platelets. B) low blood pressure. C) activation of the immune response. D) loss of hemoglobin.

B) low blood pressure.

Vitamin B12 or folate deficiency anemia usually exhibits a red blood cell morphology that is: A) microcytic and hypochromic. B) macrocytic and normochromic. C) normocytic and normochromic. D) macrocytic and hypochromic.

B) macrocytic and normochromic.