Chapter 29

Question 1

What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias?
a. Poikilocytosis
b. Isocytosis
c. Anisocytosis
d. Microcytosis

Answer 1

c. Anisocytosis

Additional descriptors of erythrocytes associated with some anemias include anisocytosis (assuming various sizes) or poikilocytosis (assuming various shapes)

Question 2

What is the fundamental physiologic manifestation of anemia?
a. Hypotension
b. Hyperesthesia
c. Hypoxia
d. Ischemia

Answer 2

c. Hypoxia

The fundamental physiologic manifestation of anemia is a reduced oxygen-carrying capacity of the blood, resulting in tissue hypoxia.

Question 3

The paresthesia that occurs in vitamin b12 deficiency anemia is a result of which of the following?

a. Reduction in acetylcholine receptors in the postsynaptic nerves

b. Myelin degeneration in the spinal cord

c. Destruction of myelin in peripheral nerves

d. Altered function of neurons in the parietal lobe

Answer 3

b. Myelin degeneration in the spinal cord

Effects on the nervous system can occur if a vitamin B12 deficiency causes the anemia. Myelin degeneration may occur with the resultant loss of fibers in the spinal cord, producing paresthesia (numbness), gait disturbances, extreme weakness, spasticity, and reflex abnormalities.

Question 4

Which of the following describes how the body compensates for anemia?
a. Increasing rate and depth of breathing
b. Decreasing capillary vasoconstriction
c. Hemoglobin holding more firmly onto oxygen
d. Kidneys releasing more erythropoietin

Answer 4

a. Increasing rate and depth of breathing

Tissue hypoxia creates additional demands and compensatory actions on the pulmonary and hematologic systems. The rate and depth of breathing increase in an attempt to increase the availability of oxygen.

Question 5

Which of the following is classified as a megaloblastic anemia?
a. Iron deficiency
b. Pernicious
c. Sideroblastic
d. Hemolytic

Answer 5

b. Pernicious

Pernicious anemia is the most common type of megaloblastic anemia.

Question 6

Deficiencies in folate and vitamin B12 alter the synthesis of which of the following?
a. RNA
b. Cell membrane
c. DNA
d. Mitochondria

Answer 6

c. DNA

Deficiencies in folate and vitamin B12 result in defective erythrocyte precursor DNA synthesis

Question 7

The underlying disorder of which anemia is a result of the defective secretion of the intrinsic factor, which is essential for the absorption of vitamin B12?
a. Microcytic
b. Pernicious
c. Hypochromic
d. Hemolytic

Answer 7

b. Pernicious

Vitamin B12 deficiency causes pernicious anemia, the most common type of megaloblastic anemia.

Question 8

After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result?
a. Iron deficiency
b. Aplastic
c. Folic acid
d. Pernicious

Answer 8

d. Pernicious

From the options available, only pernicious anemia is caused by vitamin B12 deficiency, which is often associated with the end-stage type A chronic atrophic gastritis.

Question 9

What causes the atrophy of gastric mucosal cells that result in pernicious anemia?
a. Erythrocyte destruction
b. Folic acid malabsorption
c. Vitamin B12 malabsorption
d. Poor nutritional intake

Answer 9

c. Vitamin B12 malabsorption

Deficiency in intrinsic factor (IF) secretion may be congenital or may result from adult onset gastric mucosal atrophy and the destruction of parietal cells. In older adults, virtually all vitamin B12-deficiency anemia is caused by a failure of IF-related absorption.

Question 10

Which statement best describes a Schilling test?
a. Administration of radioactive cobalamin and the measurement of its excretion in the urine to test for vitamin B12 deficiency
b. Measurement of antigen-antibody immune complexes in the blood to test for hemolytic anemia
c. Measurement of serum ferritin and total iron-binding capacity in the blood to test for iron deficiency anemia
d. Administration of folate and measurement in 2 hours of its level in a blood sample to test for folic acid deficiency anemia.

Answer 10

a. Administration of radioactive cobalamin and the measurement of its excretion in the urine to test for vitamin B12 deficiency.

The Schilling test indirectly evaluates vitamin B12 absorption by administering radioactive B12 and measuring excretion in the urine.

Question 11

What is the treatment of choice for pernicious anemia (PA)?
a. Cyanocobalamin by oral intake
b. Vitamin B12 by injection
c. Ferrous fumarate by Z-track injection
d. Folate by oral intake

Answer 11

b. Vitamin B12 by injection

Replacement of vitamin B12 (cobalamin) is the treatment of choice for PA. Initial injections of vitamin B12 are administered weekly until the deficiency is corrected, followed by monthly injections for the remainder of the individual’s life.

Question 12

Which condition resulting from untreated pernicious anemia (PA) is fatal?
a. Brain hypoxia
b. Liver hypoxia
c. Heart failure
d. Renal failure

Answer 12

c. Heart failure

Of the options available, untreated PA is fatal, usually because of heart failure.

Question 13

How is the effectiveness of vitamin B12 therapy measured?
a. Reticulocyte count
b. Serum transferring
c. Hemoglobin
d. Serum vitamin B12

Answer 13

a. Reticulocyte count

The effectiveness of cobalamin replacement therapy is determined by a rising reticulocyte count.

Question 14

Which statement about folic acid is false?

a. Folic acid absorption is dependent on the enzyme folacin.

b. Folic acid is stored in the liver.

c. Folic acid is essential for RNA and DNA synthesis within erythrocytes.

d. Folic acid is absorbed in the upper small intestine.

Answer 14

a. Folic acid absorption is dependent on the enzyme folacin.

Question 15

Which anemia produces small, pale erythrocytes?
a. Folic acid
b. Hemolytic
c. Iron deficiency
d. Pernicious

Answer 15

c. Iron deficiency

The microcytic-hypochromic anemias, which include iron deficiency anemia (IDA), are
characterized by erythrocytes that are abnormally small and contain abnormally reduced
amounts of hemoglobin

Question 16

Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails?
a. Pernicious
b. Iron deficiency
c. Aplastic
d. Hemolytic

Answer 16

b. Iron deficiency

Early symptoms of iron deficiency anemia (IDA) include fatigue, weakness, and shortness of breath. Pale earlobes, palms, and conjunctivae (see Figure 28-4) are also common signs. Progressive IDA causes more severe alterations, with structural and functional changes apparent in epithelial tissue (see Figure 28-4). The nails become brittle, thin, coarsely ridged, and spoon-shaped or concave (koilonychia) as a result of impaired capillary circulation. The tongue becomes red, sore, and painful.

Question 17

What is the most common cause of iron deficiency anemia (IDA)?
a. Decreased dietary intake
b. Chronic blood loss
c. Vitamin deficiency
d. Autoimmune disease

Answer 17

b. Chronic blood loss

The most common cause of IDA in well-developed countries is pregnancy and chronic blood loss.

Question 18

Continued therapy of pernicious anemia (PA) generally lasts how long?
a. 6 to 8 weeks
b. 8 to 12 months
c. Until the iron level is normal.
d. The rest of one’s life.

Answer 18

d. The rest of one’s life.

Because PA cannot be cured, maintenance therapy is a life-long endeavor.

Question 19

Sideroblastic anemia can occasionally result from an autosomal recessive transmission inherited from which relative?
a. Mother
b. Father
c. Grandfather
d. Grandmother

Answer 19

a. Mother

An occasional autosomal recessive transmission occurs only with mitochondrial mutations from the mother.

Question 20

Clinical manifestations of mild-to-moderate splenomegaly and hepatomegaly, bronze-colored skin, and cardiac dysrhythmias are indicative of which anemia?
a. Iron deficiency
b. Pernicious
c. Sideroblastic
d. Aplastic

Answer 20

c. Sideroblastic

Of the options available, only sideroblastic anemia exhibits mild-to-moderate enlargement of the spleen (splenomegaly) and liver (hepatomegaly), as well as abnormal skin pigmentation (bronze colored). Heart rhythm disturbances, along with congestive heart failure, are major life-threatening complications related to cardiac iron overload.

Question 21

Considering sideroblastic anemia, what would be the expected effect on the plasma iron levels?
a. Plasma iron levels would be high.
b. Levels would be low.
c. Levels would be normal.
d. Levels would be only minimally affected.

Answer 21

a. Plasma iron levels would be high.

Question 22

In aplastic anemia (AA), pancytopenia develops as a result of which of the following?
a. Suppression of erythropoietin to produce adequate amounts of erythrocytes
b. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes
c. Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes
d. Lack of stem cells to form sufficient quantities of leukocytes

Answer 22

b. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes.

AA is a critical condition characterized by pancytopenia, which is a reduction or absence of all three blood cell types, resulting from the failure or suppression of bone marrow to produce adequate amounts of blood cells.

Question 23

What is the most common pathophysiologic process that triggers aplastic anemia (AA)?
a. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells
b. Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells
c. Autoimmune disease against hematopoiesis by activated immunoglobulins
d. Inherited genetic disorder with recessive X-linked transmission

Answer 23

a. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells

Most cases of AA result from an autoimmune disease directed against hematopoietic stem cells. Tc cells appear to be the main culprits.

Question 24

An allogenic bone marrow transplantation remains the preferred method for treating which anemia?
a. Polycythemia vera
b. Aplastic
c. Sideroblastic
d. Anemia of chronic disease (ACD)

Answer 24

b. Aplastic

Of the options available, bone marrow and, most recently, peripheral blood stem cell transplantation from a histocompatible sibling are the preferred treatments for the underlying bone marrow failure observed in aplastic anemias.

Question 25

Which statement is true regarding warm autoimmune hemolytic anemia?

a. Warm autoimmune hemolytic anemia occurs primarily in men.

b. It is self-limiting and rarely produces hemolysis.

c. Erythrocytes are bound to macrophages and sequestered in the spleen.

d. Immunoglobulin M coats erythrocytes and binds them to receptors on monocytes.

Answer 25

c. Erythrocytes are bound to macrophages and sequestered in the spleen.

The immunoglobulin G-coated red blood cells bind to the Fc receptors on monocytes and splenic macrophages and are removed by phagocytosis.

Question 26

When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice?

a. Erythrocytes are destroyed in the spleen.

b. Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin.

c. The patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT).

d. The erythrocytes are coated with an immunoglobulin.

Answer 26

b. Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin.

Jaundice (icterus) is present when heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin.

Question 27

Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?
a. Aplastic
b. Sideroblastic
c. Anemia of chronic disease
d. Iron deficiency

Answer 27

c. Anemia of chronic disease

Anemia of chronic disease results from a combination of (1) decreased erythrocyte life span, (2) suppressed production of erythropoietin, (3) ineffective bone marrow erythroid
progenitor response to erythropoietin, and (4) altered iron metabolism and iron
sequestration in macrophages.

Question 28

What is the primary cause of the symptoms of polycythemia vera?
a. Decreased erythrocyte count
b. Destruction of erythrocytes
c. Increased blood viscosity
d. Neurologic involvement

Answer 28

c. Increased blood viscosity

As polycythemia vera progresses, many of the symptoms are related to the increased blood cellularity and viscosity.

Question 29

Treatment for polycythemia vera involves which of the following?
a. Therapeutic phlebotomy and radioactive phosphorus
b. Restoration of blood volume by plasma expanders
c. Administration of cyanocobalamin
d. Blood transfusions

Answer 29

a. Therapeutic phlebotomy and radioactive phosphorus

In low-risk individuals, the recommended therapy is phlebotomy and low-dose aspirin, whereas radioactive phosphorus has been used to suppress erythropoiesis.

Question 30

Considering iron replacement therapy prescribed for iron deficiency anemia, who is likely to require long-term daily maintenance dosage?
a. A woman who has not yet experienced menopause
b. A teenager who is involved in strenuous athletics
c. A middle-aged man who smokes two packs of cigarettes a day
d. An older person demonstrating signs of dementia

Answer 30

a. A woman who has not yet experienced menopause

Menstruating women may need daily oral iron replacement therapy (325 mg/day) until menopause as a result of their menstrual blood loss

Question 31

Which statement is true regarding the physical manifestations of vitamin B12 deficiency anemia?

a. Vitamin B12 deficiency anemia seldom results in neurologic symptoms.

b. The chances of a cure are good with appropriate treatment.

c. The condition is reversible in 75% of the cases.

d. Symptoms are a result of demyelination.

Answer 31

d. Symptoms are a result of demyelination.

The neurologic manifestations characteristic of vitamin B12 deficiency anemia result from
nerve demyelination that may produce neuronal death