1.3 Hypochromic and Microcytic Anemias

Question 1

The osmotic fragility test result in a patient with thalassemia major would most likely show:
A. Increased hemolysis
B. Decreased hemolysis
C. Normal resistance to hemolysis
D. Decreased hemolysis after incubation at 37C

Answer 1

B. Decreased hemolysis

Osmotic fragility is decreased because numerous target cells are present and have increased surface volume in patients with thalassemia major.

Question 2

All of the following are characteristics findings in a patient with IDA except:
A. Microcytic, hypochromic RBC morphology
B. Decreased serum iron and ferritin levels
C. Decreased total iron-binding capacity (TIBC)
D. Increased RBC protoporhyrin

Answer 2

C. Decreased total iron-binding capacity (TIBC)

Question 3

IDA may be distinguished from anemia of chronic infection by:
A. Serum iron level
B. RBC morphology
C. RBC indices
D. TIBC

Answer 3

D. TIBC

Question 4

Which anemia has RBC morphology similar to that seen in IDA (Iron deficiency anemia)?
A. Sickle cell anemia
B. Thalassemia syndrome
C. Pernicious anemia
D. HS

Answer 4

B. Thalassemia syndrome

Thalassemia and IDA are both classified as microcytic, hypochromic anemias. IDA is caused by defective heme synthesis, whereas thalassemia is caused by decreased globin chain synthesis.

Question 5

IDA is characterized by:
A. Decreased plasma iron, decreased % saturation, increased TIBC
B. Decreased plasma iron, decreased % plasma ferritin, normal RBC porphyrin
C. Decreased plasma iron, decreased % saturation, decreased TIBC
D. Decreased plasma iron, increased % saturation, decreased TIBC

Answer 5

A. Decreased plasma iron, decreased % saturation, increased TIBC

Question 6

Storage iron is usually best determined by:
A. Serum transferrin levels
B. Hgb values
C. Myoglobin values
D. Serum ferritin levels

Answer 6

D. Serum ferritin levels

Question 7

All of the following are associated with sideroblastic anemia except:
A. Increased serum iron
B. Ringed sideroblasts
C. Hypochromic anemia
D. Decreased serum ferritin

Answer 7

D. Decreased serum ferritin

Question 8

What is the basic hematological defect seen in patients with thalassemia major?
A. DNA synthetic defect
B. Hgb structure
C. Beta-chain synthesis
D. Hgb phosphorylation

Answer 8

C. Beta-chain synthesis

Question 9

Which of the following is the primary Hgb in patients with thalassemia major?
A. Hgb D
B. Hgb A
C. Hgb C
D. Hgb F

Answer 9

D. Hgb F

Patients with thalassemia major are unable to synthesize the Beta-chain; hence, little or no Hgb A is produced. However, y-chains continue to be synthesized and lead to variable elevations of Hgb F in these patients.

Question 10

A patient has an Hct of 30%, an Hgb of 8 g/dL, and a RBC count of 4.0 x 10^12/L. What is the morphological classification of this anemia?
A. Normocytic, normochromic
B. Macrocytic, hypochromic
C. Microcytic, hypochromic
D. Normocytic, hyperchromic

Answer 10

C. Microcytic, hypochromic

The indices will provide a morphological classification of this anemia. MCV is 75 fL ( reference range 80-100 fL), MCH is 20 pg ( reference range 27-31 pg), and MCHC is 26.6% (reference range 32-36%). Therefore, the anemia is microcytic hypochromic.

Question 11

In which of the following conditions is Hgb A2 elevated?
A. Hgb H
B. Hgb SC disease
C. Beta-thalassemia minor
D. Hgb S trait

Answer 11

C. Beta-thalassemia minor

In thalassemia major, there is little or no prodution of the Beta-chain, resulting in severly depressed or no synthesis of Hgb A. Severe anemia is seen, along with skeletal abnormalitites and marked splenomegaly. The patient is usually supported with transfusion therapy.

Question 12

Which of the following parameters may be similar for the anemia of inflammation and IDA?
A. Normocytic indices
B. Decreased serum iron concentration
C. Ringed sideroblasts
D. Pappenheimer bodies

Answer 12

B. Decreased serum iron concentration