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Question 1

Stages of erythrocyte formation

Answer 1

Pronormoblast
Basophilic normoblast
Polychromatic normoblast
Orthochromatic normoblast
Polychromatic erythrocytes (reticulocytes)
Mature erythrocyte (RBC)

Question 2

Mean Corpuscular Hemoglobin (MCH)

Answer 2

 Average hemoglobin volume in average RBC
 MCH = HGB/RBC count
 Correlates linearly with MCV
 Normal value is 26-33 picogram

Question 3

Mean Corpuscular Hemoglobin Concentration (MCHC)

Answer 3

 Concentration of hemoglobin in a given RBC volume
 MCHC = HGB/HCT
 Normal value is 32 to 36g/dl
 Low MCHC: Hypochromia

Question 4

RBC Distribution Width (RDW)

Answer 4

Normal value is 11-15%

Question 5

Peripheral blood smear

Answer 5

Drop of blood smeared on a glass slide
 Stained using Wright Giemsa stain
 Observation under microscope

Question 6

The normal percentage of reticulocytes

Answer 6

0.5-1.5%

Question 7

If > 1.5 =

Answer 7

reticulocytosis: hemolytic anemia & acute blood loss

Question 8

If < 0.5

Answer 8

reticulocytopenia: BM failure & nutritional deficiencies

Question 9

Corrected reticulocytes count

Answer 9

 AKA: Corrected reticulocyte index
 Reticulocytes count x (HCT/45)
 If it is ≥ 2: truly elevated = hemolytic anemia (compensatory)  If it is < 2: reduced = BM failure (inadequate response)

Question 10

BM biopsy:

Answer 10

 Done if reticulocytes count is low

 Used to investigate failed erythropoiesis

Question 11

Functional classification (according to the cause)

Answer 11

Blood loss
Hypo proliferative
Maturation defect
Hemolytic

Question 12

Acute:

Answer 12

internal hemorrhage

Question 13

Chronic

Answer 13

 More dangerous
 Mainly in elderly
 Sign of malignancy (colon cancer)  Sign of peptic ulcer disease

Question 14

Hypoproliferative

Answer 14

BM aplasia
Myelophthisic anemia
Anemia of chronic disease
Anemia of organ failure
Dilutional anemia of pregnancy (plasma ↑ in pregnancy)

Question 15

BM aplasia

Answer 15

 Anemia
 Leukopenia
 Thrombocytopenia

Question 16

Maturation defect:

Answer 16

a- Cytoplasmic maturation defect
b- Nuclear maturation defect
c- Combined maturation defect

Question 17

Microcytic anemia

Answer 17

(if MCV is less than 80)
a- Iron deficiency anemia
b- Thalassemia
c- Sideroblastic anemia: abnormal heme synthesis
d- Some cases of anemia of chronic disease

Question 18

Normocytic anemia (if MCV is normal)

Answer 18

a- Hemolytic anemia
b- BM suppression (by antibodies, infection or drugs)
c- Anemia of chronic disease

Question 19

Macrocytic anemia

Answer 19

Megaloblastic anemia:

Non-megaloblastic

Question 20

Megaloblastic anemia:

Answer 20

Findings in blood smear 
 Macro-ovalocytes
 Hypersegmented neutrophils
 Anisocytosis (variation in size)
 Poikilocytosis (variation in shape)

Caused by
 Vitamin B12 deficiency
 Folic acid deficiency

Question 21

Non-megaloblastic

Answer 21

 Chronic liver disease
 Alcoholism
 Aplastic anemia
 Hypothyroidism

Question 22

Iron deficiency anemia

Answer 22

a- Excess iron loss in hemorrhage (chronic blood loss): PUD and CRC

b- Inadequate iron intake in poor diet and malabsorption (celiac disease)

c- Increased physiologic demand
 Puberty
 Pregnancy
 Lactation

d- Functional inaccessibility of iron
 Infection
 Inflammation
 Malignancy

Question 23

Disorders of heme synthesis:

Answer 23

sideroblastic anemia
 Lead poisoning
 Genetic