Deck 20: Disorders of Iron Kinetics and Heme Metabolism

Question 1

Which of following are typical laboratory results for ACI?

A)decreased ferritin and decreased bone marrow Prussian blue staining
B)low serum iron and high TIBC
C)low serum iron and low TIBC
D)increased transferrin saturation and decreased FEP

Answer 1

low serum iron and low TIBC

Question 2

Which of the following red cell inclusions is or are often found in lead poisoning?

A)Howell-Jolly bodies
B)basophilic stippling
C)Heinz bodies
D)Cabot rings

Answer 2

basophilic stippling

Question 3

Why is too much iron dangerous?

A)Transferrin, which carries iron, causes cellular swelling and lysis.
B)The oxygen carried by excess iron oxidizes neurologic cells.
C)Iron's breakdown products cause excretion of vitamins C and E.
D)Free radicals and superoxide formed from ferrous iron plus oxygen damage cell membranes.

Answer 3

Free radicals and superoxide formed from ferrous iron plus oxygen damage cell membranes.

Question 4

Which of the following characterizes stage 1 iron deficiency?
AnemiaMCVFerritin

A)Present Decreased Decreased
B)Present Normal Normal
C)Absent Normal Decreased
D)Absent Decreased Normal

Question 5

Which of the following is decreased in patients with hereditary hemochromatosis?

A)albumin
B)serum iron
C)transferrin saturation
D)ferritin

Question 6

Most of the clinical findings in the porphyrias are related to

A)accumulated porphyrin compounds in tissue.
B)anemia.
C)reduction in heme production.
D)iron being unavailable.

Question 7

Which of the following groups is least likely to develop iron deficiency?

A)infants
B)young men
C)teenage girls
D)adult premenopausal women

Question 8

Transfusion-related hemochromatosis is seen in patients who

A)had an adverse reaction to a blood transfusion.
B)received the wrong type of blood.
C)had lifelong repeated red cell transfusions.
D)received a transfusion from a relative.

Question 9

What would be the likely findings if a bone marrow aspiration were performed in a complicated case of iron deficiency anemia?

A)increased myeloid-to-erythroid (M:E) ratio and increased staining with Prussian blue
B)shaggy polychromatophilic normoblasts and no staining with Prussian blue
C)polychromatophilic normoblasts with copious pink cytoplasm and no staining with Prussian blue
D)increased M:E ratio and increased ringed sideroblasts

Question 10

Where is most of the iron in the body found?

A)attached to hemoglobin in the red blood cells (RBCs)
B)stored in macrophages in the bone marrow
C)attached to transferrin
D)myoglobin

Question 11

What parameter of the routine complete blood count (CBC)is a sensitive indicator of preclinical iron deficiency?

A)red blood cell distribution width (RDW)
B)hematocrit
C)mean cell hemoglobin (MCH)
D)red blood count

Question 12

Which test will rise first after successful treatment for iron deficiency?

A)reticulocyte count
B)ferritin
C)MCV
D)hemoglobin

Question 13

How does lead exposure and the porphyrias cause anemia?

A)cause destruction of red cells
B)chelate iron from the body
C)impair iron absorption
D)interfere with heme production

Question 14

Which of the following results is or are typical in stage 3 iron deficiency anemia?

A)elevated reticulocyte percentage
B)thrombocytopenia
C)macrocytic red cells
D)low mean cell volume (MCV), MCH, and mean cell hemoglobin concentration (MCHC)

Question 15

What is the mechanism for ACI?

A)Acute phase reactants impair iron mobilization.
B)Inflammation and infections slow heme development.
C)Cytokines prevent iron incorporation into protoporphyrin.
D)Bone marrow iron stores are depleted by acute phase reactants.

Question 16

What is most likely if a 10-month-old child fed only cow's milk has the following results?
· Serum iron decreased
· Total iron-binding capacity (TIBC)increased
· Ferritin decreased

A)lead poisoning
B)chronic disease
C)iron deficiency from increased need and inadequate diet
D)iron deficiency from chronic blood loss

Question 17

Which group of patients is most likely to develop iron deficiency from increased need?

A)young men
B)infants and young children
C)postmenopausal women
D)middle-aged men

Question 18

Which of the following is the best test to distinguish iron deficiency anemia from ACI?

A)serum iron
B)hemoglobin
C)free erythrocyte protoporphyrin (FEP)
D)ferritin

Question 19

Lack of accessible iron is the mechanism for iron deficiency in which of the following?

A)hemochromatosis
B)hemosiderosis
C)lead poisoning
D)anemia of chronic inflammation (ACI)

Question 20

Which of the following promotes increased iron absorption?

A)repeated phlebotomy
B)eating iron-rich foods along with those high in ascorbic acid
C)desferrioxamine
D)vegetarian diet

Question 21

Ringed sideroblasts are a reflection of iron-laden

A)mitochondria.
B)Golgi complex.
C)ribosomes.
D)rough endoplasmic reticulum.

Question 22

Why is lead poisoning of particular concern in children?

A)Severe anemia may develop.
B)Impaired mental development may occur.
C)Secondary iron deficiency may develop.
D)FEP may accumulate.

Question 23

All of the following are true about hepcidin except that

A)it is an acute phase protein.
B)it is a hormone.
C)it decreases in response to increased ferritin.
D)it increases in response to increased iron stores.

Question 24

Which of the following is true of stage 3 iron deficiency?

A)Serum transferrin receptors are decreased.
B)FEP is increased.
C)The number of sideroblasts is normal.
D)The red cell count is increased, whereas the hematocrit is decreased.

Question 25

Which of the following would point to iron deficiency anemia as opposed to the ACI?

A)anemia
B)high transferrin
C)low serum iron
D)elevated FEP

Question 26

Chronic blood loss leads to

A)iron deficiency anemia.
B)ACI.
C)megaloblastic anemia.
D)hemolytic anemia.

Question 27

Ringed sideroblasts are seen in

A)inherited sideroblastic anemia.
B)acquired hemochromatosis.
C)iron deficiency anemia.
D)ACI.