Anemia

Question 1

Reticulocyte

Answer 1

Does not Contain nucleus

Still contain RNA

Question 2

In the bone marrow, the first morphologically recognizable erythroid precursor is the………..

This cell can undergo four to five cell divisions, which result in the production of…………

With increased …………. production, or the administration of it as a drug, early progenitor cell numbers are amplified and, in turn, give rise to increased numbers of erythrocytes

Answer 2

pronormoblast

16–32 mature red cells

EPO

Question 3

EPO is measured in the blood by

Answer 3

Sensitive immunoassays

Question 4

سلايد 10مهم

Question 5

With increasing ……..the level of EPO needed to sustain normal hemoglobin levels appear to increase

👧 👦 /EPO كةمتر

Answer 5

Age

Question 6

Hemoglobin lower than ……… ,EPO increases …………..ly

Answer 6

12
Logarithmic

Question 7

With EPO stimulation, red cell production can increase…………….. period, but only in the presence of adequate nutrients, especially……..

Answer 7

Four to five fold within a 1 to 2 week

Iron

Question 8

……………than hemoglobin levels in assessing anemia because they are calculated rather than measured directly

Answer 8

Hematocrit levels are less useful

Question 9

The mean hematocrit value for adult males is …………..and that for adult females is………….

Answer 9

47% (±7%)

42% (±5%)

Question 10

With acute blood loss, hypovolemia dominates the clinical picture, and the hematocrit and hemoglobin levels do not reflect the volume of blood lost

Answer 10

لأن خوين لة دةست دةد ، كامل ، مع المكونات ايضاَ

Question 11

If blood loss is mild, enhanced O2 delivery is achieved through changes in the ……………mediated by a decreased pH or increased CO2 (Bohr effect)

Answer 11

O2–hemoglobin dissociation curve

Question 12

When…………..blood volume is lost suddenly, patients are unable to compensate with the usual mechanisms of vascular contraction and changes in regional blood flow .

Answer 12

> 30% of the

Question 13

If the volume of blood lost is……………, signs of hypovolemic; shock including confusion, dyspnea, diaphoresis, hypotension, and tachycardia appear

Answer 13

> 40% (i.e., >2 L in the average-sized adult)

Question 14

An indirect measure of serum transferrin

Answer 14

Total iron binding capacity (TIBC)

Question 15

because of the intrinsic compensatory mechanisms the gradual onset of anemia—particularly in young patients

Answer 15

—may not be associated with signs or symptoms until the anemia is severe (hemoglobin <70–80 g/L [7–8 g/dL])

This compensatory mechanism can only maintain normal tissue O2 delivery in the face of a 20–30 g/L (2–3 g/dL) deficit in hemoglobin concentration

Question 16

The skin and mucous membranes may be pale if the hemoglobin

If the palmar creases are lighter in color than the surrounding skin when the hand is hyperextended, the hemoglobin level

Answer 16

is <80–100 g/L (8–10 g/dL)

is usually <80 g/L (8 g/dL)

Question 17

Glucose-6-phosphate dehydrogenase (G6PD) deficiency and certain hemoglobinopathies are seen more commonly in

Answer 17

Middle Eastern or African origin, including African Americans

Question 18

Further protection of O2 delivery to vital organs is achieved by the shunting of blood away from organs that are relatively rich in blood supply

Answer 18

Particularly the kidney, gut, and skin

Question 19

Splenomegaly and lymphadenopathy suggest an underlying………………

……………suggest platelet dysfunction

Answer 19

lymphoproliferative disease
petechiae

Question 20

M/E ratio

Answer 20

Myeloid cells to nucleated Erythroid cells.

Question 21

س٢١

Question 22

Microcytosis

macrocytosis

The MCH and MCHC reflect defects in hemoglobin synthesis ()

Answer 22

MCV (<80)

MCV (>100)

Hyper or hypochromasia

Question 23

Hemochromatosis due to

Answer 23

Inherited abnormality

Recurrent blood transfusion

Question 24

Reticulocytes

Answer 24

Larger than RBCs

Grayish blue in color on wright -giemsa stain

Residual amount of ribosomal RNA.

Question 25

من التصنيفات الأولية للأنيميا

Answer 25

هي مقارنة عدد الReticulocytes,
مع الأستجابة المتوقعة

Question 26

To use the reticulocyte count to estimate marrow response, two corrections are necessary //س٤٢

Answer 26

First/
‎في حال درصد زياد بويبويد ولكن عدد نة
Second/
‎لنحدد اذا خرجوا من نخاع العظم بصورة غير ناضجة ام لا
فقط في حالpolychromatophilic macrocytes))a))

Question 27

Shift cells and relationships with 2nd correction

Answer 27

Premature Reticulocytes /survive as reticulocytes in circulation for >1 day
thereby providing a falsely high estimate of daily red cell production/so the (second correction) is imp

Question 28

First
Second

Answer 28

First
Second

Index of morrow production
Reticulocytes production index

Question 29

Transferrin saturation

Answer 29

Serum iron divided by TIBC
Then multiplied by 100

Question 30

Sideroblasts

Answer 30

Ferritin granules within erythroblasts

Question 31

The normal serum iron ranges from ……………, whereas the normal TIBC is ……………; the normal transferrin saturation ranges from…………

Answer 31

9 to 27 μmol/L (50–150 μg/dL)

54–64 μmol/L (300–360 μg/dL);

25 to 50%

Question 32

Serum ferritin

Answer 32

Adult males have serum ferritin levels that average ∼100 μg/L, corresponding to iron stores of ∼1 g

Adult females have lower serum ferritin levels averaging 30μg/L, reflecting lower iron stores (∼300 mg)

A serum ferritin level of 10–15 μg/L indicates depletion of body iron stores

As a rule, a serum ferritin >200 μg/L means there is at least some iron in tissue stores
يعني دوو گرام حديد هةس لةبدن كة زرع بيية ليلا ولةولا

Question 33

……………. suggests a defect in the maturation of red cell precursors in the bone marrow or fragmentation of circulating red cells

Answer 33

Poikilocytosis
اشكال مختلفة عن الطبيعي

Question 34

Red cells that are slightly larger than normal
grayish blue in color on the Wright geimsa stain
The blood smear may also reveal polychromasia

‏

Answer 34

‏These cells are reticulocytes that have been prematurely released from the bone marrow, and their color represents residual amounts of ribosomal RNA

Question 35

‏The appearance of………………………, and others may provide clues to specific disorders

Answer 35

‏nucleated red cells
‏Howell-Jolly bodies
‏target cells
‏sickle cells

Question 36

Blood smear of sever iron deficiency anemia

Answer 36

‏
‏Microcytosis
‏Hypochromasia
‏Anisocytosis
‏Poikylocytosis,

Question 37

Howell -joly bodies

Answer 37

‏
‏In the absence of functional ((spleen))
‏Nuclear remnants aren’t culled from the red cells and remain as small homogeneously staining blue inclusions on wright stain.

Question 38

‏Red cell changes in myelofibrosis

‏

Answer 38

Tear drop-shaped cell
Nucleated cell

Question 39

Target cells

Answer 39

‏
‏Have bull’s eye /چشم گاوى
‏Are seen in thalassemia and liver disease

Question 40

Red cell fragmentation

Answer 40

‏May occurs with presence of foreign bodies in the circulation such as
‏1/Mechanical heart valves
‏2/Thermal injury

Question 41

‏Spur cells /Acanthocytes

‏(Burr cells =echinocytes)at uremia

‏RBCs containing several irregularly distributed thorn like projections

‏Have regularly spiny projections.

Answer 41

Spur cells /Acanthocytes

‏ at uremi(Burr cells =echinocytesa

Question 42

A patient with a……………… and a reticulocyte production index <2 will demonstrate an M/E ratio of 2 or 3:1

In contrast, patients with………………. and a production index >3 will have an M/E ratio of at least 1:1

Answer 42

hypo-proliferative anemia

hemolytic disease

Question 43

A ……………is typically seen with a low reticulocyte production index together with little or no change in red cell morphology (a normocytic, normochromic anemia)
يعني اگر بتواند دروسبكةد ،خاس دروسكةد

………………typically have a slight to moderately elevated reticulocyte production index that is accompanied by either macrocytic or microcytic red cell indices

…………….results in an increase in the reticulocyte production index ((to at least three times normal)) provided sufficient iron is available

Answer 43

hypoproliferative anemia

Maturation disorders

hemolysis

Question 44

Hemorrhagic anemia does not typically result in Reticulocyte production indices of more than………….. normal because of the limitations placed on expansion of the erythroid marrow by………….

Answer 44

2.0–2.5 times

iron availability

Question 45

With a hypoproliferative anemia, no erythroid hyperplasia is noted in the marrow,

Answer 45

whereas patients with ineffective red cell production have erythroid hyperplasia and an M/E ratio <1:1

قصدي دروستكردني خلاياي دم معيب ولكن وة فرةيي لأن مشكلة هالة نضج وليس كار نخاع عظمي

Question 46

A hypoproliferative anemia can result from

Answer 46

marrow damage,
iron deficiency, or
inadequate EPO stimulation

Question 47

How can hypothyroidism lead to hypo-proliferative anemia

Answer 47

Dec of (metabolism)=Dec of oxygen demand=Dec of erythropoietin

Question 48

With……………or………….., the EPO deficiency may be more marked than would be predicted by the degree of renal insufficiency

Answer 48

diabetes mellitus or myeloma

Question 49

In acute or chronic inflammation,
Changes in iron

These changes in iron values are brought about by hepcidin, the iron regulatory hormone that is produced by the liver and is increased in inflammation

Answer 49

نفس تغيرات انيميا مع مرض مزمن

serum iron (low)
TIBC (normal or low)
percent transferrin saturation (low)
serum ferritin (normal or high)

Question 50

Nuclear maturation defects result from

Answer 50

vitamin B12 or folic acid deficiency
drug damage (interfere with cellular DNA synthesis, such as methotrexate or alkylating agents)
or myelodysplasia /DNAخراوبوود

Question 51

In maturation disorders,bone morrow examination shows , erythroid ……………..

Answer 51

Hyperplasia

Question 52

Myelodysplasia give rise to macrocytosis anemia

Answer 52

لأن DNAونضج بوون خراوكةد

Question 53

Cytoplasmic maturation defects result from

Answer 53

severe iron deficiency
or abnormalities in globin or heme synthesis

Question 54

Anemia with alcoholism

Answer 54

Folic acid deficiency/macrocytosis

Question 55

Iron deficiency anemia:-

Mild to moderate

Sever

Answer 55

Hypo-proliferative anemia

marrow will become hyperplastic despite the inadequate iron supply/ ineffective erythropoiesis with a cytoplasmic maturation defect

Question 56

Hemolytic anemia

Answer 56

Reticulocyte production index more or equal than 2.5
(Polychromasia +macrocytes )لأن نخاع العظم خاس كاركةد وسريع سريع خلاياي تازة خةدة خوين لذا غير ناضج ن

فرق بكة وةل (immature disorders)لةولا (index)گةورا نيية

Question 57

it is important to evaluate the patient’s……………… fully before and during the treatment of any anemia

Answer 57

iron status