Deck 19: Anemias: Red Blood Cell Morphology and Approach to Diagnosis

Question 1

Describe the morphologic appearance of the red cells given the following results.
RBC: 1.89 * 10¹²/L
Hemoglobin: 7.5 g/dL
Hematocrit: 21.0%
RDW: 18.5

A)macrocytic with anisocytosis
B)normocytic normochromic with anisocytosis
C)microcytic hypochromic with little anisocytosis
D)macrocytic with most cells the same size

Answer 1

macrocytic with anisocytosis

Question 2

The red cell histogram is wider than normal.Which of the following is true?

A)The red blood cell distribution width (RDW) is decreased.
B)Most cells are larger than normal.
C)The coefficient of variation was calculated incorrectly.
D)Anisocytosis is present.

Answer 2

Anisocytosis is present.

Question 3

Which of the following conditions would warrant a bone marrow aspiration?

A)iron deficiency in a patient with colon cancer
B)severe hereditary spherocytosis
C)disseminated intravascular coagulation (DIC) with very low hemoglobin and marked red cell fragments
D)not possible to determine obvious reason for anemia

Answer 3

not possible to determine obvious reason for anemia

Question 4

Which of the following red blood cell (RBC)findings is specific for a certain condition as opposed to being nonspecific and found in many conditions?

A)ovalocytes
B)poikilocytosis
C)sickle cells
D)burr cells

Question 5

Two different patients both have hemoglobins in the 5.0 to 6.0 g/dL range.One has pallor,fatigue,and headaches,whereas the other is experiencing life-threatening shock.Which of the following is probably the major difference between the two patients?

A)the morphologic classification of the anemia
B)whether other cell lines (platelets or white cells) are also involved
C)the patient's sex
D)how quickly the anemia developed

Question 6

Which of the following is typically a macrocytic anemia?

A)thalassemia
B)iron deficiency
C)folate deficiency
D)aplastic

Question 7

An appropriately increased RPI greater than 3 is associated with

A)iron deficiency anemia.
B)macrocytic megaloblastic anemia.
C)hemolytic anemia.
D)sideroblastic anemia.

Question 8

Which of the following is a microcytic anemia?

A)B12 deficiency
B)sickle cell anemia
C)iron deficiency
D)hereditary spherocytosis

Question 9

Which of the following is an example of a morphologic classification of anemia?

A)normocytic normochromic
B)loss of blood
C)increased destruction
D)impaired production

Question 10

Which shape of red cell is described as a round,dense cell with no area of central pallor?

A)sickle cell
B)target cell
C)burr cell
D)spherocyte

Question 11

Which of the following disorders would be consistent with the previously mentioned parameters?

A)anemia of chronic disease
B)aplastic anemia
C)vitamin B12 deficiency
D)thalassemia

Question 12

What percentage of red cells is destroyed and replaced daily in a normal adult?

A)1%
B)5%
C)10%
D)20%

Question 13

Compare results of various tests in effective versus ineffective erythropoiesis.

A)Both have increased rate of erythropoiesis in the bone marrow.
B)Both have an elevated reticulocyte production index (RPI) greater than 3.
C)Both have normal release of RBCs from the bone marrow.
D)Both have significantly shortened red cell survival in circulation.

Question 14

The reticulocyte response in patients with moderate anemia is often misinterpreted as adequate if:

A)the count is not expressed in absolute terms or corrected for anemia.
B)the red cell indices are not considered.
C)a bone marrow aspirate is not examined.
D)red cell morphology is not considered.

Question 15

What test is used along with the mean cell volume (MCV)to morphologically classify anemias?

A)red blood count
B)hemoglobin
C)hematocrit
D)RDW

Question 16

What is the best definition of anemia?

A)red cell count 10% lower than the patient's baseline
B)decreased hemoglobin, hematocrit, and red cell count compared with healthy people in the same demographic group
C)hemoglobin below 12 g/dL
D)any clinical condition resulting in shortness of breath, increased heart rate, pallor, and fatigue

Question 17

What is the approximate average life span of a normal RBC in circulation?

A)10 Days
B)20 Days
C)80 Days
D)120 Days

Question 18

The anemia found in liver disease is

A)macrocytic nonmegaloblastic.
B)microcytic hypochromic.
C)macrocytic megaloblastic.
D)microcytic normochromic.

Question 19

Which of the following is true of ineffective erythropoiesis?

A)Lymphopenia and anemia are present.
B)RBC production in bone marrow is increased.
C)Release of RBCs to the peripheral blood is normal.
D)RBC survival in circulation is less than 40 days.

Question 20

All of the following are physiologic adaptations the body makes when a slow drop in the number of red cells occurs except

A)erythropoietin level increases.
B)oxygen dissociation curve shifts to left.
C)cardiac output increases.
D)respiratory rate increases.

Question 21

Match the letter of the correct composition for the inclusion with the number for the inclusion.
Correct identification of inclusions in RBCs, when present, provides useful clinical information. They often help suggest the possible cause of an anemia and thus further appropriate testing. The first list provides some red cell inclusions. The second list provides choices for composition.

Basophilic stippling

A)Ferric nonheme iron
B)Deoxyribonucleic acid (DNA)
C)Precipitated ribonucleic acid (RNA)
D)Denatured hemoglobin

Question 22

Match the letter of the correct composition for the inclusion with the number for the inclusion.
Correct identification of inclusions in RBCs, when present, provides useful clinical information. They often help suggest the possible cause of an anemia and thus further appropriate testing. The first list provides some red cell inclusions. The second list provides choices for composition.

Pappenheimer body

A)Ferric nonheme iron
B)Deoxyribonucleic acid (DNA)
C)Precipitated ribonucleic acid (RNA)
D)Denatured hemoglobin

Question 23

Match the letter of the correct composition for the inclusion with the number for the inclusion.
Correct identification of inclusions in RBCs, when present, provides useful clinical information. They often help suggest the possible cause of an anemia and thus further appropriate testing. The first list provides some red cell inclusions. The second list provides choices for composition.

Heinz body

A)Ferric nonheme iron
B)Deoxyribonucleic acid (DNA)
C)Precipitated ribonucleic acid (RNA)
D)Denatured hemoglobin

Question 24

Match the letter of the correct composition for the inclusion with the number for the inclusion.
Correct identification of inclusions in RBCs, when present, provides useful clinical information. They often help suggest the possible cause of an anemia and thus further appropriate testing. The first list provides some red cell inclusions. The second list provides choices for composition.

Howell-Jolly body

A)Ferric nonheme iron
B)Deoxyribonucleic acid (DNA)
C)Precipitated ribonucleic acid (RNA)
D)Denatured hemoglobin