Deck 7: Megaloblastic Anemias

Question 1

What protein is responsible for vitamin B₁₂ transport to the bone marrow?

A) Transcobalamin II
B) Intrinsic factor
C) Interleukin-3
D) Thymidine triphosphate
E) None of the above

Answer 1

Transcobalamin II

Question 2

What findings distinguishes megaloblastic anemia due to vitamin B₁₂ deficiency from that due to folate deficiency?

A) Severe neurologic manifestation
B) Jaundice
C) Abnormal epithelial cells
D) High reticulocyte count
E) None of the above

Answer 2

Severe neurologic manifestation

Question 3

What statement is true regarding pancytopenia?

A) Decreased RBC
B) Decreased white blood cells (WBCs)
C) Decreased platelets
D) All of the above
E) None of the above

Answer 3

All of the above

Question 4

Where is vitamin B₁₂ stored?

A) Pancreas
B) Liver
C) Kidney
D) Bone marrow
E) None of the above

Question 5

Which of the following can lead to a folic acid deficiency?

A) Malabsorption
B) Poor diet
C) Hemolytic anemia
D) All of the above
E) None of the above

Question 6

What hematologic parameter on an automated instrument would be increased in megaloblastic anemia?

A) MCH (mean corpuscular hemoglobin)
B) MCHC (mean corpuscular hemoglobin concentration)
C) MCV (mean corpuscular volume)
D) RBC count
E) None of the above

Question 7

What two dietary substances are essential for DNA synthesis?

A) Folic acid/carotene
B) Vitamin B₁₂/folic acid
C) Vitamin B₁₂/cyanocobalamin
D) Iron/globin
E) Transferrin/vitamin B₁₂

Question 8

What is most striking when viewing the peripheral smear of a severely anemic patient with megaloblastic anemia?

A) Anisocytosis
B) Poikilocytosis
C) Macro-ovalocytes
D) Hypersegmented neutrophils
E) All of the above

Question 9

What is the most common red cell inclusion body seen in megaloblastic anemia?

A) Cabot ring
B) Howell-Jolly body
C) Basophilic stippling
D) Hemoglobin H bodies
E) None of the above

Question 10

In megaloblastic anemia, the absolute reticulocyte count is decreased as a result of:

A) Effective erythropoiesis
B) Ineffective erythropoiesis
C) Medullary hematopoiesis
D) Extramedullary hematopoiesis
E) None of the above

Question 11

What is the primary cause of vitamin B₁₂ deficiency?

A) Fish tapeworm infection
B) Malabsorption
C) Poor diet
D) Transportation defect
E) None of the above

Question 12

What is the etiology of ineffective hematopoiesis in megaloblastic anemia?

A) Decreased mature cells in peripheral blood
B) Premature death of precursor cells in the bone marrow
C) Increased mature cells in peripheral blood
D) A and B
E) None of the above

Question 13

Which cell lineage may also be affected by megaloblastic change?

A) Megakaryocytic
B) Lymphocytic
C) Granulocytic
D) A and C
E) B and C

Question 14

A patient with pernicious anemia has the following indices: mean corpuscular volume (MCV) >100 fL, mean corpuscular hemoglobin (MCH) = 31 pg, mean corpuscular hemoglobin concentration (MCHC) = 33% What might be seen on the peripheral smear?

A) Codocytes
B) Macrocytes
C) Microcytes
D) Schistocytes
E) None of the above

Question 15

Which of the following is a form of megaloblastic anemia?

A) Pernicious anemia
B) Aplastic anemia
C) Sideroblastic anemia
D) Sickle cell anemia
E) None of the above

Question 16

What is the leading cause of anemia in an alcoholic?

A) Vitamin B₁₂ deficiency
B) Iron deficiency
C) Folate deficiency
D) Uridine triphosphate deficiency
E) None of the above

Question 17

What is the morphological classification of megaloblastic anemia?

A) Microcytic hypochromic
B) Macrocytic hypochromic
C) Macrocytic normochromic
D) Microcytic normochromic
E) Normocytic normochromic

Question 18

The presence of polychromatophilic macrocytes in a treated megaloblastic anemia is due to:

A) RBC degeneration
B) Reticulocytosis
C) Macrocytosis
D) Megaloblastoid dyspoiesis
E) None of the above

Question 19

An elderly white male of Scandinavian descent presents with the following hematopoietic studies: MCV = 115 fL, 3+ oval macrocytes, 20% hypersegmented neutrophils. What hematologic condition is suspected?

A) Iron-deficiency anemia
B) Megaloblastic anemia
C) Thalassemia
D) Anemia of chronic disorders
E) None of the above

Question 20

What protein is responsible for vitamin B₁₂ absorption?

A) Transcobalamin
B) Interleukin-3
C) Intrinsic factor
D) Erythropoietin
E) None of the above

Question 21

The reversed myeloid-erythroid ratio in the bone marrow of a person with megaloblastic anemia is defined as:

A) Myeloid hyperplasia
B) Erythroid hypoplasia
C) Erythroid hyperplasia
D) Hypocellularity
E) None of the above

Question 22

All of the following are initial diagnostic tests performed simultaneously in determining the cause of macrocytosis except:

A) Reticulocyte count
B) Serum and red cell folate
C) Schilling test
D) Serum vitamin B₁₂
E) None of the above

Question 23

What other hematologic condition would present a similar peripheral blood picture as megaloblastic anemia?

A) Hemoglobinopathies
B) Myelodysplastic syndromes
C) Chronic leukemia
D) Anemia of chronic disorders
E) None of the above

Question 24

Which of the following is not a cause of vitamin B₁₂ deficiency?

A) Gastrectomy
B) Blind loop syndrome
C) Blood loss
D) Fish tapeworm (Diphyllobothrium latum)
E) Diseases of the ileum

Question 25

A lack of intrinsic factor is diagnostic for which of the following?

A) Vitamin B₁₂ deficiency
B) Folate deficiency
C) Pernicious anemia
D) All of the above
E) None of the above

Question 26

How is asynchrony defined?

A) Normal nuclear and cytoplasm development of hematopoietic cells in bone marrow
B) Lack of normal nuclear and cytoplasm development of hematopoietic cells in the bone marrow
C) Lack of normal nuclear and cytoplasm development of hematopoietic cells in peripheral blood
D) Normal nuclear and cytoplasm development in hematopoietic cells in peripheral blood
E) None of the above

Question 27

What percentage of megaloblastic anemia is due to vitamin B₁₂ or folic acid deficiency?

A) 50%
B) 90%
C) 40%
D) 60%
E) 20%

Question 28

Which hematologic condition is indicated with a macrocytosis and a reticulocyte count of >5%?

A) Iron-deficiency anemia
B) Hemolytic anemia
C) Megaloblastic anemia
D) Thalassemia
E) None of the above

Question 29

In megaloblastic anemia, the band and metamyelocyte may exhibit:

A) Toxic granulation
B) Auer rods
C) Giantism
D) Pelger-Huët anomaly
E) None of the above