CHAPTER 23: INTRODUCTION TO INCREASED DESTRUCTION OF ERYTHROCYTES

Question 1

(1) The term hemolytic disorder in general refers to a disorder in which there is:

a. Increased destruction of RBCs after they enter the bloodstream
b. Excessive loss of RBCs from the body
c. Inadequate RBC production by the bone marrow
d. Increased plasma volume with unchanged red cell mass

Answer 1

a. Increased destruction of RBCs after they enter the bloodstream

Question 2

(2) RBC destruction that occurs when macrophages ingest and destroy RBCs is termed:

a. Extracellular
b. Macrophage-mediated
c. Intra-organ
d. Extrahematopoietic

Answer 2

b. Macrophage-mediated

Question 3

(3) A sign of hemolysis that is typically associated with both fragmentation and macrophage-mediated hemolysis is:

a. Hemoglobinuria
b. Hemosiderinuria
c. Hemoglobinemia
d. Elevated urinary urobilinogen level

Answer 3

d. Elevated urinary urobilinogen level

Question 4

(4) An elderly white woman is evaluated for worsening anemia, with a decrease of approximately 0.5 mg/dL of hemoglobin each week. The patient is pale, and her skin and eyes are slightly yellow. She complains of extreme fatigue and is unable to complete the tasks of daily living without napping in mid-morning and midafternoon. She also tires with exertion, finding it difficult to climb even five stairs. Which of the features of
this description points to a hemolytic cause for her anemia?

a. Pallor
b. Yellow skin and eyes
c. Need for naps
d. Tiredness on exertion

Answer 4

b. Yellow skin and eyes

Question 5

(5) Which of the following tests provides a good indication of accelerated erythropoiesis?

a. Urine urobilinogen level
b. Hemosiderin level
c. Reticulocyte count
d. Glycated hemoglobin level

Answer 5

c. Reticulocyte count

Question 6

(6) A 5-year-old girl was seen by her physician several days prior to this visit and was diagnosed with pneumonia. Her mother has brought her to the physician again because the girl’s urine began to darken after the first visit and now is alarmingly dark. The girl has no history of anemia, and there is no family history of any hematologic disorder. The CBC shows a mild anemia, polychromasia, and a few schistocytes. This anemia could be categorized as:

a. Acquired, fragmentation
b. Acquired, macrophage-mediated
c. Hereditary, fragmentation
d. Hereditary, macrophage-mediated

Answer 6

a. Acquired, fragmentation

Question 7

(7) A patient has a personal and family history of a mild hemolytic anemia. The patient has consistently elevated levels of total and indirect serum bilirubin and urinary urobilinogen. The serum haptoglobin level is consistently decreased, whereas the reticulocyte count is elevated. The latter can be seen as polychromasia on the patient’s blood film, along with spherocytes. Which of the findings reported for this patient is inconsistent with a classical diagnosis of fragmentation hemolysis?

a. Elevated total and indirect serum bilirubin
b. Elevated urinary urobilinogen
c. Decreased haptoglobin
d. Spherocytes on the peripheral film

Answer 7

d. Spherocytes on the peripheral film

Question 8

(8) Select the statement that is true about bilirubin metabolism.

a. Indirect bilirubin is formed in the liver by the addition of two sugar molecules to direct bilirubin.
b. Macrophages of the spleen liberate bilirubin during hemoglobin catabolism.
c. Urobilinogen is not water soluble and is not excreted in the urine.
d. Normally, the major fraction of bilirubin in the blood is the direct (conjugated) form released from macrophages

Answer 8

b. Macrophages of the spleen liberate bilirubin during hemoglobin catabolism.

Question 9

(9) A patient has anemia that has been worsening over the last several months. The hemoglobin level has been declining slowly, with a drop of 1.5 g/dL of hemoglobin over about 6 weeks. Polychromasia and anisocytosis are seen on the blood film, consistent with the elevated reticulocyte count and RBC distribution width (RDW). Serum levels of total bilirubin and indirect fractions are normal. Urinary urobilinogen level also is normal. When these findings are evaluated, the conclusion is drawn that the anemia does not have a hemolytic component. Based on the data given here, why was hemolysis ruled out as the cause of the anemia?

a. The decline in hemoglobin is too gradual to be associated with hemolysis.
b. The elevation of the reticulocyte count suggests a malignant cause.
c. Evidence of increased protoporphyrin catabolism is lacking.
d. Elevated RDW points to an anemia of decreased production

Answer 9

c. Evidence of increased protoporphyrin catabolism is lacking.

Question 10

(10) Which of the following sets of test results is typically expected with chronic fragmentation hemolysis?

a. Serum haptoglobin: Inc; Urine Hemoglobin: (+); Urine Sediment Prussian Blue Stain: (+)
b. Serum haptoglobin: Dec; Urine Hemoglobin: (-); Urine Sediment Prussian Blue Stain: (-)
c. Serum haptoglobin: Dec; Urine Hemoglobin: (+); Urine Sediment Prussian Blue Stain: (+)
d. Serum haptoglobin: Inc; Urine Hemoglobin: (+); Urine Sediment Prussian Blue Stain: (-)

Answer 10

c. Serum haptoglobin: Dec; Urine Hemoglobin: (+); Urine Sediment Prussian Blue Stain: (+)