Introduction to Anemia's

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Choyte02
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140503
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Introduction to Anemia's
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2012-03-14 07:57:47
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Hematology
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Microcytic/Hypochromic Anemia's
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  1. Decrease in RBC count, Hgb, or Hct.
    Anemia
  2. What are some signs and symptoms when you have a sudden loss of Hgb, RBC count, or Hct? (30% or more)
    Shock or shutdown
  3. What are some signs and symptoms when you have a slow loss of Hgb, RBC count, or Hct?
    • increase in heart and respiration rate
    • increase in cardiac output
    • right shift in O2 saturation
  4. Name 3 of the five causes for hypoproliferation:
    • Iron decrease
    • decrease in erythropoietin
    • marrow failure
    • Hemopoietic stem cell arrest or damage
    • bone marrow replacement due to cancer
  5. What are 3 pathophysiological causes of anemia?
    • Hypoproliferation
    • Maturation Disorders
    • Hemolysis
  6. What are 2 things that are affected by maturation disorders, and describe how they are affected.
    • Nuclear abnormality (B12 deficiency) nucleus does not develop as fast as cytoplasm.
    • Cytoplasmic abnormality (Thalassemia) globulin chains are not being synthesized at the proper rate.
  7. Give the type of hemolysis based off the following definition:
    Problem is within the red cell or cell membrane
    Intracorpuscular (congenital)
  8. Give the type of hemolysis based off the following definition:
    Caused by antibodies, mechanical damage
    Extracorpuscular (acquired)
  9. Main component of RBC
    Physiologic carrier of oxygen to tissue and acts as a buffer to handle CO2 formed in metabolic activities
    Hemoglobin
  10. Name 3 methods of measuring hemoglobin:
    • Cyanmethemoglobin
    • Oxyhemoglobin
    • Method in which iron content is measured
  11. Name this test used to diagnose anemia:
    Measures packed cell volume
    Ratio of the volume of RBC's to the volume of whole blood
    Hematocrit
  12. What is the reference range for hematocrit? (female and male)
    • Men: 42% - 52%
    • Women: 37% - 47%
  13. What does MCV measure and what is the reference range for MCV?
    • Measures average volume
    • Reference range: 80 - 100 fl (femtoliters)
  14. What does MCH measure and what is the reference range for MCH?
    • Measures the content of hgb in the avg. RBC
    • Reference range: 27 - 31 pg (picograms)
  15. What does MCHC measure and what is the reference range for MCHC?
    • Average concentration of hgb in a volume of packed RBCs
    • Reference range: 32 - 36%
  16. When doing a peripheral blood smear what are 3 things that can be observed when trying to diagnose an anemia?
    • size and shape
    • hgb content can be inspected visually
    • RBC morphological abnormalities
  17. Why is a reticulocyte count used as a test to diagnose anemia's and what is the normal range for reticulocytes?
    • Useful in determining the response and potential of the bone marrow.
    • Reference range: 0.5 - 2.0%
  18. Name 4 things that can be observed in a bone marrow smear or biopsy:
    • Evaluate and interpret RBC and WBC maturation
    • Prescence of megakaryocytes
    • Ratio of myeloid to erythroid cells
    • Abundance of iron stores
    • Presence or absence of granulomas
    • Tumor cells
    • Overall estimate of BM celluarity
  19. Group of red cell disorders that involve a defect in hgb synthesis due to deficiency of iron and abnormal utilization of iron.
    Microcytic and Hypochromic Anemias
  20. What are 2 types of microcytic and hypochromic anemias?
    • Iron deficiency anemia (IDA) - most common
    • Anemia of Chronic Disease (ACD) - sideroblastic anemia
  21. What are the 3 major roles of Fe?
    • Cellular growth
    • O2 Transport
    • Poroliferation of RBCs
  22. What is the normal range for total body iron?
    3500-4000 mg
  23. Where is 2/3 of the total body iron found?
    In hgb
  24. Where is 1/3 of the total body iron found?
    Stored found in the storage pool of bone marrow, liver, and spleen.
  25. Where does regulation of Fe absorbtion occur?
    Intestinal Mucosa
  26. What are the 2 storage forms of Fe?
    • Ferritin
    • Hemosiderin
  27. Name the storage form of Fe based off following characteristics:
    Major storage form of iron
    Water soluble
    Easily mobilized by the body for utilization
    Ferritin
  28. Name the storage form of Fe based off following characteristics:
    Not water soluble
    Released more slowly than ferritin
    Less readily available for utilization
    Hemosiderin
  29. Total amount of iron that can be bound by transferrin in plasma or serum.
    Total Iron binding Capacity (TIBC)
  30. Test used to measure transferrin bound iron
    Serum iron
  31. Which of the following laboratory results would not be a usual criterion for making a diagnosis of anemia?
    A. Decreased hgb level
    B. Decreased platelet count
    C. Decreased RBC count
    D. Decreased hct level
    B. decreased platelet count
    (this multiple choice question has been scrambled)
  32. What condition is not a cause of anemia?
    a. dietary deficiency
    b. moderate excercise
    c. decreased RBC production
    d. increased RBC destruction or loss
    b. moderate excercise
  33. Which response represents the most complete and correct listing of the most common clinical signs of anemia?
    A. rapid pulse, inflammation, temperature elevation, dehydration
    B. nausea, hypertension, temperature elevation, melena
    C. fatigue, weakness, dyspnea, pallor
    D. urticaria, hypertension, inflammation, nausea
    C. fatigue, weakness, dyspnea, pallor
    (this multiple choice question has been scrambled)
  34. What is the most commonly accepted method for measuring hemoglobin?
    A. Conversion of hemoglobin to oxyhemoglobin, followed by spetrophotometric measurement
    B. Iron content measured by radioimmunoassay technique
    C. Copper sulfate measured by specific gravity
    D. Conversion of hemoglobin to cyanmethemoglobin, followd by spectrophotometric measurement
    D. Conversion of hemoglobin to cyanmethemoglobin, followd by spectrophotometric measurement
    (this multiple choice question has been scrambled)
  35. How is hct measured on automated hematology instruments?
    A. Calculation (MCV X RBC count)
    B. Centrifugation
    C. Photometrically
    D. Calculation (MCH X Hgb)
    A. Calculation (MCV X RBC count)
    (this multiple choice question has been scrambled)
  36. Which of the following would not be characteristically found on a peripheral blood smear in a case of anemia?
    A. Basophillic stippling, Howell-Jolly bodies, and Pappenheimer bodies
    B. Dohle bodies and toxic granules
    C. Anisocytosis and/or Poikilocytosis
    D. Cabot rings and Heinz bodies
    B. Dohle bodies and toxic granules
    (this multiple choice question has been scrambled)
  37. What is the diagnostic value of the reticulocyte count in the evaluation of anemia?
    A. Determines the corrected RBC count after calculation
    B. Determines response and potential of the bone marrow
    C. Determines compensation mechanisms for anemia
    D. Determines the potential sampling error for RBC count
    B. Determines response and potential of the bone marrow
    (this multiple choice question has been scrambled)
  38. Which of the following is a lesser factor to be considered in the interpretation of a bone marrow aspirate smear?
    A. Estimate of bone marrow activity
    B. Type and amount of hemoglobin
    C. Maturation of red and white blood cell series
    D. M:E ratio
    B. Type and amount of hemoglobin
    (this multiple choice question has been scrambled)
  39. Caused by defective DNA sythesis
    Macrocytic Anemia's
  40. Macrocytic Anemia:
    Defect is manifested by the presence of ____________ in the bone marrow and _______________ in the peripheral blood.
    Megaloblasts; Macro-ovalocytes
  41. Megoblastic anemia is associated with ineffective ___________ and ___________.
    Erythropoeisis; Hemolysis
  42. What are 4 causes of non-megaloblastic anemia?
    • Alcoholism
    • Liver Disease
    • Hematologic Diseases
    • Hemolytic Anemia
  43. Patients with megaloblastic anemia have a ____________ bone marrow.
    Hypercellular
  44. In Reference to Megaloblastic Anemia:
    The myeloid to erythroid (M:E) ratio is______________.
    Decreased
  45. Name this phenomenon:
    Nuclear chromatin appears loose and less mature than the nuclear chromatin of the normal red cells at the same stage of maturation.
    Nuclear to Cytoplasm asynchrony
  46. A macrocytic, normochromic anemia.
    Megaloblastic Anemia
  47. Peripheral Blood Morphology; Macrocytic/Normochromic Anemia:
    What is the MCV range?
    100-160 fL
  48. Peripheral Blood Morphology; Macrocytic/Normochromic Anemia:
    Does the MCH increase, decrease or stay within a normal range?
    increase (elevate)
  49. Peripheral Blood Morphology; Macrocytic/Normochromic Anemia:
    Does the MCHC increase, decrease or stay within a normal range?
    Normal
  50. What are some of the abnormal blood morphologies you would notice on a peripheral blood smear for a patient with a macrocytic anemia?
    • Presence of macrocytes and macro-ovalocytes
    • Varied aniso and poikilocytosis
  51. What are some of the red cell inclusions you would notice on a peripheral blood smear for a patient with a macrocytic anemia?
    • Howell Jolly Bodies
    • Basophillic Stippling
    • Cabot rings
  52. Macrocytic/Normochromic Anemia:
    Hypersegmented neutrophils are seen in what percentage of cases?
    98%
  53. Vitamin B12 is also know as:
    Cobalamin
  54. What produces vitamin B12?
    Microorganisms and Fungi
  55. What is a major source of vitamin B12?
    Liver
  56. What is the daily recommended intake for vitamin B12?
    5 µg
  57. B12 plays an important role in two key reactions:
    First, it is necessary in the synthesis of ____________ from __________________.
    Second, vitamin B12 is important in conversion of _____________, a Krebs cycle intermediate, to ______________.
    • methionine; homocystine
    • methymalonyl COA; succinyl COA
  58. What are two causes of vitamin B12 deficiency?
    Nutritional; Malabsorption (pernicious anemia)
  59. The most common form of intestinal malabsoprtion is:
    Pernicious Anemia
  60. What is the cause for pernicios anemia?
    Deficiency of intrinsic factor
  61. What is the cause of a decrease in intrinsic factor?
    gastric parietal cell atrophy, which is associated with a contamitant decrease in other gastric juices
  62. What are 4 charecteristics of pernicious anemia?
    • Nuclear/cytoplasm asynchrony
    • Lack of nuclear maturation and mitosis
    • Large cell size
    • Ineffective erythropoiesis
  63. What are 4 clinical manifestations of pernicious anemia?
    • Pallor
    • Weakness
    • Jaundice
    • Smooth tongue
    • Anemia insidious
    • Neurological signs- motor disturbances, control issues
  64. Test that evaluates the pathophysiology of viatmin B12 malabsorption.
    Schilling Test
  65. The pathophsysiology of megaloblastic anemia is:
    A. Defective DNA synthesis and abnormal nuclear maturation.
    B. Defective RNA synthesis and abnormal cytoplasm maturation.
    C. Defective DNA synthesis and abnormal cytoplasm maturation.
    D. Defective RNA synthesis and abnormal nuclear maturation.
    A. Defective DNA sythesis and abnormal nuclear maturation.
    (this multiple choice question has been scrambled)
  66. Which of the following laboratory findings coincide with megaloblastic anemia?
    A. Increased serum iron and serum bilirubin
    B. Decreased serum muramidase
    C. Decreased serum iron and serum bilirubin
    D. Increased haptoglobin
    A. Increased serum iron and serum bilirubin
    (this multiple choice question has been scrambled)
  67. Megaloblastic anemia is associated with:
    A. Ineffective erythropoiesis and decreased erythropoietin
    B. Ineffective erythropoiesis and decreased reticulocytes
    C. Ineffective erythropoiesis and increased reticulocytes
    D. Ineffective erythropoiesis and decreased LDH
    B. Ineffective erythropoiesis and decreased reticulocytes
    (this multiple choice question has been scrambled)
  68. According to the morphological classification of anemias, megaloblastic anemia is a:
    A. macrocytic, hyperchromic anemia
    B. macrocytic, hypochromic anemia
    C. macrocytic, normochromic anemia
    D. normocytic, normochromic anemia
    C. macrocytic, normochromic anemia
    (this multiple choice question has been scrambled)
  69. Which of the following are not seen on the peripheral smear of a patient with megaloblastic anemia?
    A. Macro-ovalocytes
    B. Hyposegmented neutrophils
    C. Hypersegmented neutrophils
    D. Howell-Jolly bodies
    B. Hyposegmented neutrophils
    (this multiple choice question has been scrambled)
  70. Which of the following are the characteristic findings of the bone marrow in a patient with megaloblastic anemia?
    A. Hypercellular with low M:E ratio
    B. Hypocellular with high M:E ratio
    C. Hypocellular with low M:E ratio
    D. Hypercellualr with high M:E ratio
    A. Hypercellular with low M:E ratio
    (this multiple choice question has been scrambled)
  71. The glycoprotein necessary for absorbtion of vitamin B12 is:
    A. Intrinsic factor
    B. Transcobalamin II
    C. Haptoglobin
    D. Albumin
    A. Intrinsic factor
    (this multiple choice question has been scrambled)
  72. Which of the following are clinical manifestations of both B12 deficiency and folate deficiency?
    A. hemoglobinuria
    B. thrombocytosis
    C. hemoglobinemia
    D. anemia and jaundice
    D. anemia and jaundice
    (this multiple choice question has been scrambled)
  73. Which of the following Schilling test results corresponds to a diagnosis of pernicious anemia?
    a. Part I abnormal, part II not corrected
    b. Part I abnormal, part II corrected
    d. Part I and part II abnormal
    c. Part I normal, part II corrected
    b. Part I abnormal, part II corrected
  74. Which of the following is not a cause of vitamin B12 deficiency? a. Atrophic gastritis
    b. Total gastrectomy
    c. Blind Loop syndrome
    d. Chronic glossitis
    d. Chronic glossitis
  75. Macrocytosis associated with acute blood loss is characterized by:
    a. decreased reticulocyte count
    b. increased reticulocyte count
    d. panocytopenia
    c. macro-ovalocytes
    b. increased reticulocyte count
  76. Which of the following is associated with pernicious anemia and not macrocytic anemia due to liver disease?
    A. Increased MCV
    B. Hypersegmented neutrophils
    C. Increased LD
    D. Increased bilirubin
    B. Hypersegmented neutrophils
    (this multiple choice question has been scrambled)
  77. Decrease or absent synthesis of one of the constituent globin chains due to genetic mutation.
    Thalassemia
  78. Decrease or absent β chain syntheis
    Beta Thalassemia
  79. Decrease or absent α chain synthesis.
    Alpha Thalassemia
  80. Seen primarily in Mediterranean.
    Beta thalassemia
  81. Seen primarily in Southeast Asia and Continental Africa.
    Alpha thalassemia
  82. What does a decrease in the production of one of the globulin chains result in?
    • a decrease in the amount of normal physiologic hgb produced
    • relative excess of the other globin chain
  83. What are 3 routine hematology procedures?
    • Automated blood analyzers; use of RBC indices
    • Peripheral Smear Examination
    • Supravital stains
  84. Plays an important role in the diagnosis of thalassemia
    Detects increased level of Hgb A2, Hgb F, and the presence of abnormal Hgbs
    Performed at a akaline pH around 8.4
    Hemoglobin electrophoresis
  85. What are the two defective gene types?(β genes)
    • βo - Absent beta chain synthesis
    • β+ - Block or decrease beta chain synthesis
  86. Why doesn't β thalassemia occur in utero?
    Because the fetus produces fetal hgb (Hgb F)
  87. What is two other names for β thalassemia major?
    • Cooley's Anemia
    • Homozygous Anemia
  88. What are some symptoms of β Thalassemia Major?
    • Decreased growth and tissue profusion(inadequate O2 supply)
    • Cardiac failure
    • Chronic hemolysis
    • Bone thinning
    • Extramedullary hematopoiesis
    • Hepatosplenomegaly
  89. What is the hemoglobin defect found in thalassemia syndromes?
    A. Excessive production of porphyrins
    B. Amino acid substitution
    C. Defective production of the globin portion
    D. Abnormal incorporation of iron molecule
    C. Defective production of the globin portion
    (this multiple choice question has been scrambled)
  90. What type of globin chains and hemoglobin are charecteristics of severe α thalassemia?
    A. Two α chains and two δ chains (HbA2)
    B. Two α chains and two ᵞ chains (HbF)
    C. Two α chains and two β chains (HbA)
    D. Four β chains (HbH) or four ᵞ chains (Hb Bart's)
    D. Four β chains (HbH) or four ᵞ chains (Hb Bart's)
    (this multiple choice question has been scrambled)
  91. Which type of thalassemia has primarily hemoglobin Bart's and shows the following clinical expressions: infants die in utero or soon after birth, severe anemia, marked hepatomegaly and splenomegaly, and ascites?
    A. Thalassemia minor (β+/β)
    B. Homozygous αo thalassemia (--/--)
    C. Hemoglobin H disease (-α/--)
    D. Homozygous βo thalassemia (βoo)
    B. Homozygous αo thalassemia (--/--)
    (this multiple choice question has been scrambled)
  92. What is the term for the clinical course of homozygous
    (δβ)0 thalassemia?
    A. Thalassemia trait
    B. Thalessemia major
    C. Thalassemia intermedia
    D. Thalessemia minor
    C. Thalassemia intermedia
    (this multiple choice question has been scrambled)
  93. What is the clinical manifestation of α thalassemia with sicke cell anemia?
    A. Severe life threatening anemia
    B. Skeletal abnormality, but milder anemia than sickle cell anemia
    C. Less severe than sickle cell anemia alone
    D. Relatively asymptomatic until plaved in an oxygen deprived environment
    C. Less severe than sickle cell alone
    (this multiple choice question has been scrambled)
  94. What is the primary risk to thalassemia major patients who are on a high-transfusion (hypertransfusion) program?
    A. Electolyte imbalance
    B. Citrate toxicity
    C. Hyperviscosity of Blood
    D. Iron Overload
    D. Iron Overload
    (this multiple choice question has been scrambled)
  95. What routine hematologic finding is indicative of thalassemia?
    A. Normocytic, normochromic anemia
    B. Macrocytic, hypochromic anemia
    C. Microcytic, hypochromic anemia
    D. Macrocytic, nomochromic anemia
    C. Microcytic, hypochromic anemia
    (this multiple choice question has been scrambled)
  96. Which of the following cells are not found in a patient with homozygous β thalassemia?
    A. Ovalocytes
    B. Nucleated red cells
    C. Target cells
    D. Sickle cells


    D. Sickle cells
    (this multiple choice question has been scrambled)
  97. Which test is useful in demonstrating the distribution of hemoglobin F and in differentiating pancellular HPFH, herterocellular HPFH, and heterozygous δβ thalassemia?
    A. Complete blood count
    B. Kleihauer-Betke acid elution test
    C. Serum ferritin level
    D. Osmotic fragility
    B. Kleihauer-Betke acid elution test
    (this multiple choice question has been scrambled)
  98. Which of the following findings would be indicative of heterozygous β thalassemia?
    A. Hemoglobin A2 level of 3.5% to 7%
    B. Hemoglobin F level less than 2 %
    C. Hemoglobin A level of 65% to 85%
    D. Hemoglobin A2 level less than 3.5
    A. Hemoglobin A2 level of 3.5% to 7%
    (this multiple choice question has been scrambled)

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