Patho Chapter 13: disorders of RBCs

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."

"Clients with sickle cell anemia inherited the disease." "Sickle cell anemia is a form of hemoglobinopathy."

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

-Increase risk for infection Pancytopenia would imply a reduction in all blood cells, including white blood cells. -Anemia Pancytopenia would imply a reduction in all blood cells, including red blood cells (RBCs). -Increased risk for bleeding Pancytopenia would imply a reduction in all blood cells, including thrombocytes.

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. If hematocrit percentage is elevated, then plasma percentage is likely reduced. -Both hemoglobin and hematocrit levels are elevated. Both hemoglobin and hematocrit are higher than normal.

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

1. Pulmonary dysfunction 2. Decreased blood oxygen levels 3. Decreased oxygen delivery to kidneys 4. Increase erythropoietin levels 5. Bone marrow stimulation In COPD, prolonged hypoxemia stimulates erythropoietin release from the kidneys. This in turn stimulates the bone marrow to produce more red blood cells.

Which of the following hematocrit values would be indicative of polycythemia? 45% 60% 37% 48%

60%

On the figure, which term is used to fill in the blank box? Urobilinogen Bile Biliverdin Biliary

Biliverdin Porphyrin is converted to biliverdin, which is then converted to bilirubin.

Please indicate which box in the figure would indicate the step of erythropoietin release.

Erythropoietin stimulates bone marrow Erythropoietin is released by the kidney and activates the bone marrow.

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

Hemoglobin levels of 18 grams per deciliter This hemoglobin level is elevated and does not indicate anemia.

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

Increased reticulate percentage Reticulocytes are immature RBCs, and levels will increase to replace lost cells.

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? Hematocrit of 45% Low red blood cell number Polycythemia Vitamin B12 deficiency anemia

Low red blood cell number Erythropoietin stimulates red blood cell formation. If erythropoietin is lacking, then red blood cell formation will be reduced.

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? The number one recommendation is to increase your activity level. Do not overreact. Sickle cell anemia is not a severe disease and should not require hospitalization. Make certain you have adequate hydration and rest, and avoid stressors when possible. Use caution because your blood has limited ability to clot in a small cut may result in significant bleeding.

Make certain you have adequate hydration and rest, and avoid stressors when possible. To reduce the risk vaso-occlusive crisis, patients should maintain adequate hydration, get adequate rest, and try to avoid the stressors.

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

Megaloblastic Folic-acid deficiency results un larger-than-normal cells, which are referred to as megaloblastic.

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? Megaloblastic Microcytic Sickle cell Normocytic

Normocytic In anemia related to blood loss, cell size is not changed.

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? Polycythemia Hemophilia Sickle cell anemia Iron deficiency anemia

Sickle cell anemia Sickle cell anemia alters the shape of red blood cells (RBC's), which can lodge in capillaries.

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

Thalassemia Sickle cell anemia

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

Thalassemia is a result of a genetic mutation. Hemophilia can be an inherited disorder or arise from spontaneous mutation.

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

The decrease oxygenation of the blood associated with COPD has increased erythropoietin release. Increased erythropoietin will increase RBC levels.

In iron deficiency anemia, which serum factor may be high? Serum iron Hematocrit Hemoglobin Total iron binding capacity

Total iron binding capacity Total iron binding capacity increases when iron levels are low, indicating that there is increased space available for iron to bind.

Ethan presents with hypotension, tachycardia, and hyperventilation. You learn that he received a severe wound while using a chain saw. Laboratory results reveal low hematocrit, low hemoglobin, and normocytic normochromic anemia. What condition is consistent with these lab values? acute blood loss aplastic anemia folic acid deficiency anemia hemolytic anemia iron-deficiency anemia primary polycythemia sickle cell anemia thalassemia vitamin B12 deficiency anemia

acute blood loss The patient's injury induced acute blood loss resulting in anemia. Blood loss in this manner causes a reduction in red blood cells, lowering the percentage of red blood cells in the sample, also known as hematocrit. Hemoglobin, the protein in red blood cells, is also lost with bleeding. In this type of anemia, cell size and shape are unchanged, hence the terms normocytic and normochromic.

Rosalie reports bruising easily and nose bleeds. Bone marrow biopsy results reveal hypocellularity throughout, and CBC values show reduced red blood cells, white blood cells, platelets, and reticulocytes. What condition is consistent with these findings? acute blood loss aplastic anemia folic acid deficiency anemia hemolytic anemia iron-deficiency anemia primary polycythemia sickle cell anemia thalassemia vitamin B12 deficiency anemia

aplastic anemia Aplastic anemia may be caused by a number of factors, including some medications. In aplastic anemia, all bone marrow cell types are reduced, known as pancytopenia.

Which factor stimulates red blood cell production? tissue plasminogen activator erythropoietin angiotensin thrombin corticotropic releasing factor

erythropoietin

Deficiency in which of the following nutrients may result in megaloblastic red blood cells? Select all that apply. calcium B12 folic acid iron vitamin D

folic acid B12

Monica has Crohn's disease and has been experiencing weakness and fatigue. Peripheral blood smear shows megaloblastic cells. Blood laboratory results also show low hemoglobin and hematocrit with high mean corpuscular volume. Homocysteine levels are also high. What condition is consistent with these findings? acute blood loss aplastic anemia folic acid deficiency anemia hemolytic anemia iron-deficiency anemia primary polycythemia sickle cell anemia thalassemia vitamin B12 deficiency anemia

folic acid deficiency anemia Megaloblastic anemia may arise for folic acid deficiency, as folic acid is necessary for DNA synthesis and subsequent normal cell division. Without this nutrient, red blood cells may become enlarged, while hematocrit and hemoglobin levels are low due to poor cell synthesis. Homocysteine levels often elevate in conjunction with inadequate folate.

Stephanie has systemic lupus erythematous. Her peripheral blood smear reveals spherocytosis and poikilocytosis. Reticulocyte percentage is elevated. What condition is consistent with these findings? acute blood loss aplastic anemia folic acid deficiency anemia hemolytic anemia iron-deficiency anemia primary polycythemia sickle cell anemia thalassemia vitamin B12 deficiency anemia

hemolytic anemia Spherocytosis and poikilocytosis are apparent on peripheral blood smears in which RCB hemolysis has occurred. These terms indicate shape changes associated with hemolysis. Reticulocytes are immature red blood cells. Percentage of reticulocytes elevates in conditions such as hemolytic anemia, when a large number of red blood cells are being destroyed.

Nina, age 23, has the primary complaint of heavy menstrual periods. Blood laboratory values show low hemoglobin and hematocrit with microcytic and hypochromic cells. Serum ferritin is low with elevated total iron binding capacity. What condition is consistent with these findings? acute blood loss aplastic anemia folic acid deficiency anemia hemolytic anemia iron-deficiency anemia primary polycythemia sickle cell anemia thalassemia vitamin B12 deficiency anemia

iron-deficiency anemia Iron is an essential component in the synthesis of hemoglobin. Without adequate iron, as indicated by low serum ferritin and elevated total iron binding capacity, red blood cell formation cannot proceed as normal. Lacking the necessary hemoglobin, red blood cells take on a smaller, paler appearance.

What is one possible sign of elevated red blood cell breakdown? jaundice elevated hematocrit gastrointestinal upset headache

jaundice

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

leukocytes erythrocytes thrombocytes

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 Folic acid levels lower than 4 ng/mL MCV high Elevated tHCy levels

A characteristic of aplastic anemia is _______________. pancytopenia overproduction of red blood cells increased level of platelets primary polycythemia

pancytopenia

Prolonged hypoxia, such as occurs with chronic obstructive pulmonary disorder, may result in _________. swelling of the tongue thalassemia petechiae polycythemia

polycythemia

Peter has been experiencing headaches, tinnitus, vertigo, and nosebleeds. Blood laboratory results reveal a hemoglobin level of 18 g/dL and a hematocrit level of 55%. White blood cells and platelets are also elevated. Erythropoietin is low. What condition is consistent with these findings? acute blood loss aplastic anemia folic acid deficiency anemia hemolytic anemia iron-deficiency anemia primary polycythemia sickle cell anemia thalassemia vitamin B12 deficiency anemia

primary polycythemia In primary polycythemia, an overproduction of red blood cells occurs, independent of any secondary conditions. The fact that erythropoietin is low indicates it is not a hormonal signal stimulating red blood cell formation. Normal hemoglobin levels are 14 to 16 g/dL and normal hematocrit is 40 to 45 percent.

Because of family history, the physician orders hemoglobin electrophoresis tests for Jordan. The results are positive for hemoglobin S. What disorder does the patient have? acute blood loss aplastic anemia folic acid deficiency anemia hemolytic anemia iron-deficiency anemia primary polycythemia sickle cell anemia thalassemia vitamin B12 deficiency anemia

sickle cell anemia Electrophoresis helps to distinguish between different forms of hemoglobin based on size and shape. Hemoglobin S is the type of hemoglobin formed from the sickle cell gene.

Nassar is a child of Middle Eastern descent. Nassar's parents state that he often seems to tire easily, and he has had jaundice in the past. He also is on the lower end of the growth curve for his age. A CBC reveals low hematocrit and hemoglobin and MCHC anemia. Electrophoresis reveals Hgb with missing beta chains. What condition is consistent with these findings? acute blood loss aplastic anemia folic acid deficiency anemia hemolytic anemia iron-deficiency anemia primary polycythemia sickle cell anemia thalassemia vitamin B12 deficiency anemia

thalassemia Thalassemia is a genetic disease in which the alpha or beta chains of hemoglobin are missing or variant. This leads to anemia, jaundice and, in children, can stunt growth.

Timothy was recently diagnosed with pernicious anemia and presents with complaints of fatigue and dyspnea. He also comments that his tongue "hurts" and feels "strange," and he is experiencing tingling in his hands and fingers. Laboratory values reveal low hemoglobin and hematocrit, with high mean corpuscular volume values. What condition is consistent with these findings? acute blood loss folic acid deficiency anemia hemolytic anemia iron-deficiency anemia sickle cell anemia thalassemia vitamin B12 deficiency anemia primary polycythemia

vitamin B12 deficiency anemia In pernicious anemia, the ability to absorb vitamin B12 is compromised. As this vitamin is necessary for DNA synthesis, lack of this vitamin affects red blood cell synthesis. Abnormal DNA synthesis and an altered growth cycle result in larger than normal cells. Vitamin B12 is also important for neuronal signaling. Deficiencies in this vitamin may cause tingling sensations in the hands. It may also cause swelling of the tongue.