CHAPTER 10 Flashcards by Prince Mella

The megakaryocyte progenitor that undergoes endomitosis is:

a. MK-I
b. BFU-Meg
c. CFU-Meg
d. LD-CFU-Meg

d. LD-CFU-Meg

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The growth factor that is produced in the kidney and induces growth and differentiation of committed
megakaryocyte progenitors is:

a. IL-3
b. IL-6
c. IL-11
d. Thrombopoietin

d. Thrombopoietin

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What platelet organelle sequesters ionic calcium and binds a series of enzymes of the eicosanoid pathway?

a. Glycocalyx
b. Dense granules
c. Dense tubular system
d. Surface connected canalicular system

c. Dense tubular system

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What platelet membrane receptor binds fibrinogen and supports platelet aggregation?

a. GP Ib/IX/V
b. GP IIb/IIIa
c. GP Ia/IIa
d. P2Y1

b. GP IIb/IIIa

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What platelet membrane phospholipid flips from the inner surface to the plasma surface on activation and serves as the assembly point for coagulation
factors?

a. Phosphatidylethanolamine
b. Phosphatidylinositol
c. Phosphatidylcholine
d. Phosphatidylserine

d. Phosphatidylserine

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What is the name of the eicosanoid metabolite produced from endothelial cells that suppresses platelet activity?

a. Thromboxane A2
b. Arachidonic acid
c. Cyclooxygenase
d. Prostacyclin

d. Prostacyclin

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Which of the following molecules is stored in platelet dense granules?

a. Serotonin
b. Fibrinogen
c. Platelet factor 4
d. Platelet-derived growth factor

a. Serotonin

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What plasma protein is essential for platelet adhesion?

a. VWF
b. Factor VIII
c. Fibrinogen
d. P-selectin

a. VWF

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Reticulated platelets can be enumerated in peripheral blood to detect:

a. Impaired platelet production in disease
states
b. Abnormal organelles associated with
diseases such as leukemia
c. Increased platelet production in
response to need
d. Inadequate rates of membrane
cholesterol exchange with the plasma

c. Increased platelet production in
response to need

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White clots:

a. Occur primarily in the deep veins of the
leg
b. Are characteristic of the secondary
hemostatic process
c. Are largely composed of platelets and
von Willebrand factor
d. Form normally in response to vascular
injury and are completely harmless

c. Are largely composed of platelets and
von Willebrand factor

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Upon activation, platelets secrete their a-granule contents via:

a. The dense tubule system
b. The surface connected canalicular
system
c. The glycocalyx
d. Microtubules

b. The surface connected canalicular
system

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Microparticles:

a. Are stored in platelet dense granules
b. Inhibit blood clotting
c. Bud off of platelets after their exposure
to strong agonists
d. Exhibit no biologic activity

c. Bud off of platelets after their exposure
to strong agonists

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A 1:20 dilution of blood is made with 3% glacial acetic acid as the diluent. The four large corner squares on both sides of the hemacytometer are counted, for a total of 100 cells. What is the total WBC count (3109 /L)?

a. 0.25
b. 2.5
c. 5
d. 10

b. 2.5

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The total WBC count is 20 3 109 /L. Twenty-five NRBCs per 100 WBCs are observed on the peripheral blood film. What is the corrected WBC count (3109 /L)?

a. 0.8
b. 8
c. 16
d. 19

c. 16

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If potassium cyanide and potassium ferricyanide are used in the manual method for hemoglobin determination, the final product is:

a. Methemoglobin
b. Azide methemoglobin
c. Cyanmethemoglobin
d. Myoglobin

c. Cyanmethemoglobin

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Which of the following would NOT interfere with the result when hemoglobin determination is performed by the cyanmethemoglobin method?

a. Increased lipids
b. Elevated WBC count
c. Lyse-resistant RBCs
d. Fetal hemoglobin

d. Fetal hemoglobin

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A patient has a hemoglobin level of 8.0 g/dL. According to the rule of three, what is the expected range for the hematocrit?

a. 21% to 24%
b. 23.7% to 24.3%
c. 24% to 27%
d. 21% to 27%

d. 21% to 27%

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Calculate the MCV and MCHC for the following values: RBCs 5 5.00 3 1012/L HGB 5 9 g/dL HCT 5 30% MCV (fL) MCHC (g/dL)

a. 30 18
b. 60 30
c. 65 33
d. 85 35

b. 60 30

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What does the reticulocyte count assess?

a. Inflammation
b. Response to infection
c. Erythropoietic activity of the bone
marrow
d. Ability of red blood cells to form rouleaux

c. Erythropoietic activity of the bone
marrow

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For a patient with the following test results, which measure of bone marrow red blood cell production provides the most accurate information? Observed
reticulocyte count 5 5.3% HCT 5 35%
Morphology—moderate polychromasia

a. Observed reticulocyte count
b. Corrected reticulocyte count
c. RPI
d. ARC

c. RPI

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Given the following values, calculate the RPI: Observed reticulocyte count 5 6% HCT 5 30%

a. 2
b. 3
c. 4
d. 5

a. 2

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Which of the following would be associated with an elevated ESR value?

a. Microcytosis
b. Polycythemia
c. Decreased globulins
d. Inflammation

d. Inflammation

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Which printout lets the end user know at a glance that the results are acceptable and no manual work needs to be performed?

a. CELL-DYN Sapphire
b. UniCel DxH 800
c. ADVIA 2120i
d. Sysmex XN-series

d. Sysmex XN-series

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Which instrument printout has a system flag on the platelet count?

a. CELL-DYN Sapphire
b. UniCel DxH 800
c. ADVIA 2120i
d. XN-series

a. CELL-DYN Sapphire

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3. What do you suspect is the cause of the variation in platelet counting among the four instruments?\ a. Different instruments have different levels of sensitivity. b. All instruments use the same principle for counting platelets. c. Some instruments are susceptible to false-positive platelet flagging under certain conditions. d. Different instruments use different thresholds to capture and count platelets.

d. Different instruments use different thresholds to capture and count platelets.

4. Based on the overall flagging for this specimen on each instrument, should a manual differential count be performed for this patient? a. Yes, because immature granulocytes are present in the specimen. b. Yes, because the WBC scatterplots are abnormal. c. No, because each differential count is complete with no system or morphology flags.

c. No, because each differential count is complete with no system or morphology flags.

5. A patient peripheral blood film demonstrates agglutinated RBCs, and the CBC shows an elevated MCHC. What other parameters will be affected by the agglutination of the RBCs? a. MCV will be decreased and RBC count will be increased. b. MCV will be decreased and RBC count will be decreased. c. MCV will be increased and RBC count will be decreased. d. MCV will be increased and RBC count will be increased.

c. MCV will be increased and RBC count will be decreased.

6. Match the cell-counting methods listed with the appropriate definition:

C. Impedance - Involves detection and measurement of changes in electrical current between two electrodes B.RF - Uses high voltage electrical waves to measure the internal complexity of cells A. Optical Scatter - uses diffraction,reflection and refraction of light waves

7. Low-voltage DC is used to measure: a. Cell nuclear volume b. Total cell volume c. Cellular complexity in the nucleus d. Cellular complexity in the cytoplasm

b. Total cell volume

8. Orthogonal light scatter is used to measure: a. Cell volume b. Internal complexity of the cell c. Cellular granularity d. Nuclear density

b. Internal complexity of the cell

9. On the Beckman Coulter instruments, hematocrit is a calculated value. Which of the following directly measured parameters is used in the calculation of this value? a. RDW b. Hemoglobin c. MCV d. MCHC

c. MCV

10. Match each instrument listed with the technology it uses to determine WBC differential counts.

B. Abbott CELL-DYN Sapphire - MAPSS technology C. Sysmex XN-1000 - Forward&side light scatter D. Siemens ADVIA 2120i - Peroxidase-staining A. Beckman Coulter UniCel DxH 800 - Volume, conductivity

1. A laboratory science student consistently makes wedge technique blood films that are too long and thin. What change in technique would improve the films? a. Increasing the downward pressure on the pusher slide b. Decreasing the acute angle of the pusher slide c. Placing the drop of blood closer to the center of the slide d. Increasing the acute angle of the pusher slide

b. Decreasing the acute angle of the pusher slide

2. When a blood film is viewed through the microscope, the RBCs appear redder than normal, the neutrophils are barely visible, and the eosinophils are bright orange. What is the most likely cause? a. The slide was overstained. b. The stain was too alkaline. c. The buffer was too acidic. d. The slide was not rinsed adequately.

c. The buffer was too acidic.

3. A stained blood film is held up to the light and observed to be bluer than normal. What microscopic abnormality might be expected on this film? a. Rouleaux b. Spherocytosis c. Reactive lymphocytosis d. Toxic granulation

a. Rouleaux

5. A blood film for a very anemic patient with an RBC count of 1.25 3 1012/L shows an average of seven platelets per oil immersion field. Which of the following values most closely correlates with the estimate per microliter? a. 14,000 b. 44,000 c. 140,000 d. 280,000

b. 44,000

4. A laboratorian using the 403 objective lens sees the following numbers of WBCs in 10 fields: 8, 4, 7, 5, 4, 7, 8, 6, 4, 6. Which of the following WBC counts most closely correlates with the estimate? a. 1.5 3 109 /L b. 5.9 3 109 /L c. 11.8 3 109 /L d. 24 3 109 /L

c. 11.8 3 109 /L

6. A blood film for a patient with a normal RBC count has an average of 10 platelets per oil immersion field. Which of the following values best correlates with the estimate per microliter? a. 20,000 b. 100,000 c. 200,000 d. 400,000

c. 200,000

7. What is the absolute count (3109 /L) for the lymphocytes if the total WBC count is 9.5 3 109 /L and there are 37% lymphocytes? a. 3.5 b. 6.5 c. 13 d. 37

a. 3.5

8. Which of the following blood film findings indicates EDTAinduced pseudothrombocytopenia? a. The platelets are pushed to the feathered end. b. The platelets are adhering to WBCs. c. No platelets at all are seen on the film. d. The slide has a bluish discoloration when examined microscopically.

b. The platelets are adhering to WBCs.

9. Which of the following is the best area to review or perform a differential on a stained blood film? a. Red blood cells are all overlapped in groups of three or more. b. Red blood cells are mostly separated, with a few overlapping. c. Red blood cells look flattened, with none touching. d. Red blood cells are separated and holes appear among the cells.

b. Red blood cells are mostly separated, with a few overlapping.

10. Use the reference intervals provided inside the front cover of this text. Given the following data, summarize the following blood picture: WBC: 86.3 3 109 /L HGB: 9.7 g/dL HCT: 24.2% MCV: 87.8 fL MCHC: 33.5% PLT: 106 3 109 /L a. Leukocytosis, normocytic-normochromic anemia, thrombocytopenia b. Microcytic-hypochromic anemia, thrombocytopenia c. Neutrophilia, macrocytic anemia, thrombocytosis d. Leukocytosis, thrombocytopenia

a. Leukocytosis, normocytic-normochromic anemia, thrombocytopenia

1. Where is most hematopoietic tissue found in adults? a. Liver b. Lungs c. Spleen d. Long bones

d. Long bones

2. What is the preferred bone marrow collection site in adults? a. Second intercostal space on the sternum b. Anterior or posterior iliac crest c. Any of the thoracic vertebrae d. Anterior head of the femur

b. Anterior or posterior iliac crest

3. The aspirate should be examined under low power to assess all of the following except: a. Cellularity b. Megakaryocyte numbers c. Morphology of abnormal cells d. Presence of tumor cell clusters

c. Morphology of abnormal cells

8. Which of the following is not an indication for a bone marrow examination? a. Pancytopenia (reduced numbers of red blood cells, white blood cells, and platelets in the peripheral blood) b. Anemia with RBC indices corresponding to low serum iron and low ferritin levels c. Detection of blasts in the peripheral blood d. Need for staging of Hodgkin lymphoma

b. Anemia with RBC indices corresponding to low serum iron and low ferritin levels

4. What is the normal myeloid to erythroid (M:E) ratio range in adults? a. 1.5:1 to 3.3:1 b. 5.1:1 to 6.2:1 c. 8.6:1 to 10.2:1 d. 10:1 to 12:1

a. 1.5:1 to 3.3:1

7. What is the largest hematopoietic cell found in a normal bone marrow aspirate? a. Osteoblast b. Myeloblast c. Pronormoblast d. Megakaryocyte

d. Megakaryocyte

6. What cells, occasionally seen in bone marrow biopsy specimens, are responsible for the formation of bone? a. Macrophages b. Plasma cells c. Osteoblasts d. Osteoclasts

c. Osteoblasts

5. Which are the most common erythroid stages found in normal marrow? a. Pronormoblasts b. Pronormoblasts and basophilic normoblasts c. Basophilic and polychromatophilic normoblasts d. Polychromatophilic and orthochromic normoblasts

d. Polychromatophilic and orthochromic normoblasts

9. In a bone marrow biopsy specimen, the red blood cell precursors were estimated to account for 40% of the cells in the marrow, and the other 60% were granulocyte precursors. What is the myeloid to erythroid (M:E) ratio? a. 4:6 b. 1.5:1 c. 1:1.5 d. 3:1

b. 1.5:1

10. On a bone marrow core biopsy sample, several large cells with multiple nuclei were noted. They were located close to the endosteum, and their nuclei were evenly spaced throughout the cell. What are these cells? a. Megakaryocytes b. Osteoclasts c. Adipocytes d. Fibroblasts

b. Osteoclasts

11. The advantage of a core biopsy bone marrow sample over an aspirate is that the core biopsy specimen: a. Can be acquired by a less invasive collection technique b. Permits assessment of the architecture and cellular arrangement c. Retains the staining qualities of basophils owing to the use of Zenker fixative d. Is better for the assessment of bone marrow iron stores with Prussian blue stain

b. Permits assessment of the architecture and cellular arrangement

12. Which of the following features suggests involvement of the marrow by lymphoma? a. Paratrabecular lymphoid aggregation b. Lymphoid aggregates with germinal centers c. Non Paratrabecular lymphoid clusters d. Discrete, small lymphocytes with speckled nuclear chromatin

a. Paratrabecular lymphoid aggregation

13. Using Wright-Giemsa stain, the morphologic description of an eccentric dark nuclei with deeply basophilic (blue) cytoplasm and a prominent pale central Golgi apparatus best describes a(n): a. Eosinophil b. Basophil c. Lymphocyte d. Plasma cell

d. Plasma cell

1. The TNC count is ___/mL. a. 3 b. 7 c. 13 d. 66

b. 7

2. The RBC count is ___/mL. a. 131 b. 263 c. 1050 d. 5830

a. 131

3. Based on the cell counts, the appearance of the fluid should be: a. Turbid b. Hemolyzed c. Clear d. Cloudy

c. Clear

5. Spinal fluid was obtained from a 56-year-old woman. On receipt in the laboratory, the fluid was noted to be slightly bloody. When a portion of the fluid was centrifuged, the supernatant was clear. The cell counts were 5200 RBCs/mL3 and 24 WBCs/mL. On the cytocentrifuge preparation, several nucleated RBCs were seen. The differential was 52% lymphocytes, 20% neutrophils, 22% monocytes, 4% myelocytes, and 2% blasts. What is the most likely explanation for these results? a. Bone marrow contamination b. Bacterial meningitis c. Peripheral blood contamination d. Leukemic infiltration in the central nervous system

a. Bone marrow contamination

4. All of the following cells are normally seen in CSF, serous fluids, and synovial fluids except: a. Lining cells b. Neutrophils c. Lymphocytes d. Monocytes/histiocytes (macrophages)

b. Neutrophils

6. A 34-year-old woman with a history of breast cancer developed a pleural effusion. The fluid obtained was bloody and had a TNC count of 284/mL. On the cytocentrifuge preparation, there were several neutrophils and a few monocytes/histiocytes. There were also several clusters of large, darkstaining cells. These cell clumps appeared three dimensional and contained some mitotic figures. What is the most likely identification of the cells in clusters? a. Mesothelial cells b. Metastatic tumor cells c. Cartilage cells d. Pneumocytes

b. Metastatic tumor cells

7. A serous fluid with a clear appearance, specific gravity of 1.010, protein concentration of 1.5 g/dL, and fewer than 500 mononuclear cells/mL would be considered: a. Infectious b. An exudate c. A transudate d. Sterile

c. A transudate

8. On the cytocentrifuge slide prepared from a peritoneal fluid sample, many large cells are seen, singly and in clumps. The cells have a “fried egg” appearance and basophilic cytoplasm, and some are multinucleated. These cells should be reported as: a. Suspicious for malignancy b. Macrophages c. Large lymphocytes d. Mesothelial cells

c. Large lymphocytes

Refer to the following scenario to answer questions 9 and 10: A 56-year-old man came to the physician’s office with complaints of pain and swelling in his left big toe. Fluid aspirated from the toe was straw colored and cloudy. The WBC count was 2543/mL. The differential consisted mainly of neutrophils and monocytes/histiocytes. Intracellular and extracellular crystals were seen on the cytocentrifuge slide. The crystals were needle shaped and, when polarized with the use of the red compensator, appeared yellow on the y-axis. 9. The crystals are: a. Cholesterol b. Hyaluronidase c. Monosodium urate d. Calcium pyrophosphate

c. Monosodium urate

10. This patient’s painful toe was caused by: a. Gout b. Infection c. Inflammation d. Pseudogout

a. Gout

1. Which of the following patients would be considered anemic with a hemoglobin value of 14.5 g/dL? Refer to reference intervals inside the front cover of this text. a. An adult man b. An adult woman c. A newborn boy d. A 10-year-old girl

c. A newborn boy

2. Anemia most commonly presents with which one of the following set of symptoms: a. Abdominal pain (from splenomegaly) b. Shortness of breath and fatigue c. Chills and fever d. Jaundice and enlarged lymph nodes

b. Shortness of breath and fatigue

3. Which of the following are important to consider in the patient’s history when investigating the cause of an anemia? a. Diet and medications b. Occupation, hobbies, and travel c. Bleeding episodes in the patient or in his or her family members d. All of the above

d. All of the above

4. Which one of the following is reduced as an adaptation to long-standing anemia? a. Heart rate b. Respiratory rate c. Oxygen affinity of hemoglobin d. Volume of blood ejected from the heart with each contraction

c. Oxygen affinity of hemoglobin

5. An autoimmune reaction destroys the hematopoietic stem cells in the bone marrow of a young adult patient, and the amount of active bone marrow, including erythroid precursors, is diminished. Erythroid precursors that are present are normal in appearance, but there are too few to meet the demand for circulating red blood cells, and anemia develops. The reticulocyte count is low. The mechanism of the anemia would be described as: a. Effective erythropoiesis b. Ineffective erythropoiesis c. Insufficient erythropoiesis

c. Insufficient erythropoiesis

6. What are the initial laboratory tests that are performed for the diagnosis of anemia? a. CBC, iron studies, and reticulocyte count b. CBC, reticulocyte count, and peripheral blood film examination c. Reticulocyte count and serum iron, vitamin B12, and folate assays d. Bone marrow study, iron studies, and peripheral blood film examination

b. CBC, reticulocyte count, and peripheral blood film examination

7. An increase in which one of the following suggests a shortened life span of RBCs and hemolytic anemia? a. Hemoglobin concentration b. Hematocrit c. Reticulocyte count d. Red cell distribution width

c. Reticulocyte count

8. Which of the following is detectable only by examination of a peripheral blood film? a. Microcytosis b. Anisocytosis c. Hypochromia d. Poikilocytosis

d. Poikilocytosis

9. Schistocytes, ovalocytes, and acanthocytes are examples of abnormal changes in RBC: a. Volume b. Shape c. Inclusions d. Hemoglobin concentration

b. Shape

10. Refer to Figure 16.3 to determine which one of the following conditions would be included in the differential diagnosis of an anemic adult patient with an absolute reticulocyte count of 20 3 109 /L and an MCV of 65 fL. a. Aplastic anemia b. Sickle cell anemia c. Iron deficiency d. Folate deficiency

c. Iron deficiency

11. Which one of the following conditions would be included in the differential diagnosis of an anemic adult patient with an MCV of 125 fL and an RDW of 20 (reference interval 11.5% to 14.5%)? Refer to Table 16.4. a. Aplastic anemia b. Sickle cell anemia c. Iron deficiency d. Vitamin B12 deficiency

d. Vitamin B12 deficiency

1. The mother of a 4-month-old infant who is being breastfed sees her physician for a routine postpartum visit. She expresses concern that she may be experiencing postpartum depression because she does not seem to have any energy. Although the physician is sympathetic to the patient’s concern, she orders a CBC and iron studies seeking an organic explanation for the patient’s symptoms. The results are as follows: CBC: all results within reference intervals except the RDW, which was 15%. Serum iron: decreased TIBC: increased % transferrin saturation: decreased Serum ferritin: decreased Correlate the patient’s laboratory and clinical findings. What can you conclude? a. The results of the iron studies reveal findings consistent with a thalassemia that was apparently previously undiagnosed. b. The patient is in stage 2 of iron deficiency, before frank anemia develops. c. The results of the iron studies are inconsistent with the CBC results, and a laboratory error should be suspected. d. There is no evidence of a hematologic explanation for the patient’s symptoms.

b. The patient is in stage 2 of iron deficiency, before frank anemia develops.

2. A bone marrow biopsy was performed as part of the cancer staging protocol for a patient with Hodgkin lymphoma. Although no evidence of spread of the tumor was apparent in the bone marrow, other abnormal findings were noted, including a slightly elevated myeloid-to-erythroid ratio. WBC and RBC morphology appeared normal, however. The Prussian blue stain showed abundant stainable iron in the marrow macrophages. The patient’s CBC revealed a hemoglobin of 10.8 g/dL, but RBC indices were within reference intervals. RBC morphology was unremarkable. These findings are consistent with: a. Anemia of chronic inflammation b. Sideroblastic anemia c. Thalassemia d. Iron deficiency anemia

a. Anemia of chronic inflammation

3. Predict the iron study results for the patient with Hodgkin lymphoma described in question 2. Serum Iron Level TIBC % Transferrin Saturation Serum Ferritin Level a. Decreased Increased Decreased Decreased b. Increased Normal Increased Normal c. Increased Increased Normal Increased d. Decreased Decreased Normal Normal

d. Decreased Decreased Normal Normal

4. A 35-year-old white woman went to her physician complaining of headaches, dizziness, and nausea. The headaches had been increasing in severity over the past 6 months. This was coincident with her move into an older house built about 1900. She had been renovating the house, including stripping paint from the woodwork. Her CBC results showed a mild hypochromic, microcytic anemia, with polychromasia and basophilic stippling noted. Which of the following tests would be most useful in confirming the cause of her anemia? a. Serum lead level b. Serum iron level and TIBC c. Absolute reticulocyte count d. Prussian blue staining of the bone marrow to detect iron stores in macrophages

a. Serum lead level

5. In men and postmenopausal women whose diets are adequate, iron deficiency anemia most often results from: a. Increased need associated with aging b. Impaired absorption in the gastric mucosa c. Chronic gastrointestinal bleeding d. Diminished resistance to hookworm infections

c. Chronic gastrointestinal bleeding

6. Which one of the following individuals is at greatest risk for the development of iron deficiency anemia? a. A 15-year-old boy who eats mainly junk food b. A 37-year-old woman who has never been pregnant and has amenorrhea c. A 63-year-old man with reactivation of tuberculosis from his childhood d. A 40-year-old man who lost blood during surgery to repair a fractured leg

a. A 15-year-old boy who eats mainly junk food

7. Which of the following individuals is at the greatest risk for the development of anemia of chronic inflammation? a. A 15-year-old girl with asthma b. A 40-year-old woman with type 2 diabetes mellitus c. A 65-year-old man with hypertension d. A 30-year-old man with severe rheumatoid arthritis

d. A 30-year-old man with severe rheumatoid arthritis

8. In what situation will increased levels of free erythrocyte protoporphyrin be present? a. Loss of function mutation to one of the enzymes in the heme synthesis pathway b. A mutation that prevents heme attachment to globin so that protoporphyrin remains free c. Any condition that prevents iron incorporation into protoporphyrin IX d. When red blood cells lyse, freeing their contents into the plasma

c. Any condition that prevents iron incorporation into protoporphyrin IX

9. In the pathogenesis of the anemia of chronic inflammation, hepcidin levels: a. Decrease during inflammation and reduce iron absorption from enterocytes b. Increase during inflammation and reduce iron absorption from enterocytes c. Increase during inflammation and increase iron absorption from enterocytes d. Decrease during inflammation and increase iron absorption from enterocytes

b. Increase during inflammation and reduce iron absorption from enterocytes

10. Sideroblastic anemias result from: a. Sequestration of iron in hepatocytes b. Inability to incorporate heme into apohemoglobin c. Sequestration of iron in myeloblasts d. Failure to incorporate iron into protoporphyrin IX

d. Failure to incorporate iron into protoporphyrin IX

11. In general, most instances of hereditary hemochromatosis result from mutations that impair: a. The manner in which developing red cells acquire and manage iron b. The hepcidin-ferroportin iron regulatory system c. The TfR-Tf endocytic iron acquisition process for body cells other than red blood cells d. The function of divalent metal transporter in enterocytes and macrophages

b. The hepcidin-ferroportin iron regulatory system

12. In the erythropoietic porphyrias, mild anemia may be accompanied by what distinctive clinical finding? a. Gallstones b. Impaired night vision c. Unintentional nighttime leg movements d. Heightened propensity for sunburn

d. Heightened propensity for sunburn

1. Which of the following findings is consistent with a diagnosis of megaloblastic anemia? a. Hyposegmentation of neutrophils b. Decreased serum lactate dehydrogenase level c. Absolute increase in reticulocytes d. Increased MCV

d. Increased MCV

2. A patient has a clinical picture of megaloblastic anemia. The serum folate level is decreased, and the serum vitamin B12 level is 600 pg/mL (reference interval is 200 to 900 pg/mL). What is the expected value for the methylmalonic acid assay? a. Increased b. Decreased c. Within the reference interval

c. Within the reference interval

3. Which one of the following statements characterizes the relationships among macrocytic anemia, megaloblastic anemia, and pernicious anemia? a. Macrocytic anemias are megaloblastic. b. Macrocytic anemia is pernicious anemia. c. Megaloblastic anemia is macrocytic. d. Megaloblastic anemia is pernicious anemia.

c. Megaloblastic anemia is macrocytic.

4. Which of the following CBC findings is most suggestive of megaloblastic anemia? a. MCV of 103 fL b. Hypersegmentation of neutrophils c. RDW of 16% d. Hemoglobin concentration of 9.1 g/dL

b. Hypersegmentation of neutrophils

5. In the following description of a bone marrow smear, find the statement that is inconsistent with the expected picture in megaloblastic anemia. “The marrow appears hypercellular with a myeloid-to-erythroid ratio of 1:1 due to prominent erythroid hyperplasia. Megakaryocytes appear normal in number and appearance. WBC elements appear larger than normal, with especially large metamyelocytes, although they otherwise appear morphologically normal. Erythroid precursors also appear large. There is nuclear-cytoplasmic asynchrony, with the nucleus appearing more mature than expected for the color of the cytoplasm.” a. Erythroid nuclei that are more mature than cytoplasm b. Larger than normal WBC elements c. Larger than normal erythroid precursors d. Normal appearance of megakaryocytes

a. Erythroid nuclei that are more mature than cytoplasm

6. Which one of the following findings would be inconsistent with elevated titers of intrinsic factor blocking antibodies? a. Hypersegmentation of neutrophils b. Low levels of methylmalonic acid c. Macrocytic RBCs d. Low levels of vitamin B12

b. Low levels of methylmalonic acid

7. Which of the following is the most metabolically active form of absorbed vitamin B12? a. Transcobalamin b. Intrinsic factor-vitamin B12 complex c. Holotranscobalamin d. Haptocorrin-vitamin B12 complex

c. Holotranscobalamin

8. Folate and vitamin B12 work together in the production of: a. Amino acids b. RNA c. Phospholipids d. DNA

d. DNA

The macrocytosis associated with megaloblastic anemia results from: a. Reduced numbers of cell divisions with normal cytoplasmic development b. Activation of a gene that is typically active only in megakaryocytes c. Reduced concentration of hemoglobin in the cells so that larger cells are needed to provide the same oxygen-carrying capacity d. Increased production of reticulocytes in an attempt to compensate for the anemia

a. Reduced numbers of cell divisions with normal cytoplasmic development

10. Which one of the following groups has the highest risk for pernicious anemia? a. Malnourished infants b. Children during growth periods c. Persons older than 60 years of age d. Pregnant women

c. Persons older than 60 years of age