Chapter 29: Alterations of Erythrocyte Platelet, Hemostatic Function

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 
c. Anisocytosis
b. Isocytosis 
d. Microcytosis

Answer 1

ANS: C
Additional descriptors of erythrocytes associated with some anemias include anisocytosis
(assuming various sizes) or poikilocytosis (assuming various shapes) (see Figure 28-1).
The remaining terms are not associated with this condition.
PTS: 1 REF: Page 982

Question 2

What is the fundamental physiologic manifestation of anemia?

a. Hypotension
c. Hypoxia
b. Hyperesthesia
d. Ischemia

Answer 2

ANS: C
The fundamental physiologic manifestation of anemia is a reduced oxygen-carrying
capacity of the blood, resulting in tissue hypoxia.
PTS: 1 REF: Page 982 | Page 985

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

ANS: B
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. This selection is the only option that accurately describes the cause of
paresthesia in such anemias.
PTS: 1 REF: Page 985 | Page 987

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

ANS: A
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. This selection is the only option that accurately
describes the compensation mechanism in such anemias.
PTS: 1 REF: Page 985

Question 5

Which of the following is classified as a megaloblastic anemia?

a. Iron deficiency
c. Sideroblastic
b. Pernicious
d. Hemolytic

Answer 5

ANS: B
Pernicious anemia is the most common type of megaloblastic anemia. The remaining
options are not classified as megaloblastic anemias.
PTS: 1 REF: Pages 987-988

Question 6

Deficiencies in folate and vitamin B12 alter the synthesis of which of the following?

a. RNA
c. DNA
b. Cell membrane
d. Mitochondria

Answer 6

ANS: C
Deficiencies in folate and vitamin B12 result in defective erythrocyte precursor DNA
synthesis. These deficiencies are not associated with alterations of the other options.
PTS: 1 REF: Page 987

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
c. Hypochromic
b. Pernicious
d. Hemolytic

Answer 7

ANS: B
Vitamin B12 deficiency causes pernicious anemia, the most common type of megaloblastic
anemia.
PTS: 1 REF: Pages 987-988

Question 8

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

Answer 8

ANS: D
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.
PTS: 1 REF: Page 988

Question 9

What causes the atrophy of gastric mucosal cells that result in pernicious anemia?

a. Erythrocyte destruction
c. Vitamin B12 malabsorption
b. Folic acid malabsorption d. Poor nutritional intake

Answer 9

ANS: C
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. This
selection is the only option that accurately identifies the cause of gastric mucosal cell
atrophy.
PTS: 1 REF: Page 988

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

ANS: A
The Schilling test indirectly evaluates vitamin B12 absorption by administering radioactive
B12 and measuring excretion in the urine. This selection is the only option that accurately
describes a Schilling test.
PTS: 1 REF: Page 988

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

ANS: B
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. The other options
are not treatments for PA.
PTS: 1 REF: Page 988

Question 12

Which condition resulting from untreated pernicious anemia (PA) is fatal?

a. Brain hypoxia
c. Heart failure
b. Liver hypoxia
d. Renal failure

Answer 12

ANS: C
Of the options available, untreated PA is fatal, usually because of heart failure.
PTS: 1 REF: Page 989

Question 13

. How is the effectiveness of vitamin B12 therapy measured?

a. Reticulocyte count
c. Hemoglobin
b. Serum transferring
d. Serum vitamin B12

Answer 13

ANS: A
The effectiveness of cobalamin replacement therapy is determined by a rising reticulocyte
count. The other options are not used as indicators of the effectiveness of vitamin B12
therapy

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

ANS: A
Folic acid absorption is not dependent on the enzyme folacin. The other options are true
statements regarding folic acid.
PTS: 1 REF: Page 989

Question 15

Which anemia produces small, pale erythrocytes?

a. Folic acid
c. Iron deficiency
b. Hemolytic
d. Pernicious

Answer 15

ANS: C
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. This description is not true of the other options.
PTS: 1 REF: Pages 989-990

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
c. Aplastic
b. Iron deficiency
d. Hemolytic

Answer 16

ANS: B
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. These symptoms are not associated
with the other options.
PTS: 1 REF: Pages 990-991

Question 17

What is the most common cause of iron deficiency anemia (IDA)?

a. Decreased dietary intake c. Vitamin deficiency
b. Chronic blood loss
d. Autoimmune disease

Answer 17

ANS: B
The most common cause of IDA in well-developed countries is pregnancy and chronic
blood loss.
PTS: 1 REF: Page 990

Question 18

Continued therapy of pernicious anemia (PA) generally lasts how long?

a. 6 to 8 weeks
c. Until the iron level is normal
b. 8 to 12 months
d. The rest of one’s life

Answer 18

ANS: D
Because PA cannot be cured, maintenance therapy is a life-long endeavor.
PTS: 1 REF: Pages 988-989

Question 19

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

Answer 19

ANS: A
An occasional autosomal recessive transmission occurs only with mitochondrial mutations
from the mother.
PTS: 1 REF: Page 992

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
c. Sideroblastic
b. Pernicious
d. Aplastic

Answer 20

ANS: C
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.
PTS: 1 REF: Page 992

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

ANS: A
Plasma iron levels would be high (see Table 28-3).
PTS: 1 REF: Page 986 | Table 28-3

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 leukocyte

Answer 22

ANS: B
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. This selection is the only option that accurately
identifies the cause of pancytopenia.
PTS: 1 REF: Page 993

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

ANS: A
Most cases of AA result from an autoimmune disease directed against hematopoietic stem
cells. Tc cells appear to be the main culprits. None of the remaining options is considered
a common trigger of AA.
PTS: 1 REF: Page 995

Question 24

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

Answer 24

ANS: B
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.
PTS: 1 REF: Page 995

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

ANS: C
The immunoglobulin G–coated red blood cells bind to the Fc receptors on monocytes and
splenic macrophages and are removed by phagocytosis. The other options are not true
when considering this type of anemia.
PTS: 1 REF: Page 998

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

ANS: B
Jaundice (icterus) is present when heme destruction exceeds the liver’s ability to conjugate
and excrete bilirubin. This selection is the only option that accurately describes the process
that affects the occurrence of hemolytic anemia–related jaundice.
PTS: 1 REF: Page 1000

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
c. Anemia of chronic disease
b. Sideroblastic
d. Iron deficiency

Answer 27

ANS: C
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. This result is not true of the other options.
PTS: 1 REF: Page 1001

Question 28

What is the primary cause of the symptoms of polycythemia vera?

a. Decreased erythrocyte count
c. Increased blood viscosity
b. Destruction of erythrocytes
d. Neurologic involvement

Answer 28

ANS: C
As polycythemia vera progresses, many of the symptoms are related to the increased blood
cellularity and viscosity. No other option is the primary cause of the symptoms of
polycythemia vera.
PTS: 1 REF: Page 1003

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

ANS: A
In low-risk individuals, the recommended therapy is phlebotomy and low-dose aspirin,
whereas radioactive phosphorus has been used to suppress erythropoiesis. The other
options are not considered in the treatment of polycythemia vera.

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

ANS: A
Menstruating women may need daily oral iron replacement therapy (325 mg/day) until
menopause as a result of their menstrual blood loss. None of the other options are a
chronic source of blood loss.
PTS: 1 REF: Page 991

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

ANS: D
The neurologic manifestations characteristic of vitamin B12 deficiency anemia result from
nerve demyelination that may produce neuronal death. These complications pose a serious
threat because they are not reversible, even with appropriate treatment.
PTS: 1 REF: Page 988

Question 32

A 2000 ml blood loss will produce which assessment finding? (Select all that apply.)

a. Air hunger
b. Normal blood pressure in the supine position
c. Rapid thready pulse
d. Cold clammy skin
e. lactic acidosis

Answer 32

ANS: A, C, D
With a 2000 ml loss of blood, central venous pressure, cardiac output, and arterial blood
pressure are below normal, even when at rest and in the supine position. The person
commonly has air hunger; a rapid, thready pulse; and cold, clammy skin. With a 1500 ml
loss of blood, supine blood pressure and pulse can still be normal. Lactic acidosis is
observed with a blood loss of 2500 ml or more.
PTS: 1 REF: Page 996 | Table 28-5

Question 33

Which medications are associated with an intermediate increase in a person’s risk for
developing aplastic anemia? (Select all that apply.)
a. Penicillin
b. Chloramphenicol (Chloromycetin)
c. Phenytoin (Dilantin)
d. Trimethoprim-sulfamethoxazole (Bactrim)
e. Thiazides

Answer 33

ANS: B, C, D
Chloramphenicol (Chloromycetin), phenytoin (Dilantin), and
trimethoprim-sulfamethoxazole (Bactrim) are associated with an intermediate increase in
the risk of developing aplastic anemia. The other options are not associated with a rare
increase in risk.
PTS: 1 REF: Page 994 | Table 28-4

Question 34

Which conditions are generally included in the symptoms of pernicious anemia (PA)?
(Select all that apply.)
a. Weakness
b. Weight gain
c. Low hemoglobin
d. Paresthesias
e. Low hematocrit

Answer 34

ANS: A, C, D, E
When the hemoglobin and hematocrit levels in the blood have significantly decreased, the
individual experiences the classic symptoms of PA—weakness, fatigue, paresthesias of the
feet and fingers, difficulty in walking, loss of appetite, abdominal pains, and weight loss.
PTS: 1 REF: Page 986 | Page 988 | Table 28-

Question 35

What are the clinical manifestations of folate deficiency anemia? (Select all that apply.)

a. Constipation
b. Flatulence
c. Dysphagia
d. Stomatitis
e. Cheilosis

Answer 35

ANS: B, C, D, E
Specific symptoms of folate deficiency anemia include severe cheilosis (scales and
fissures of the lips and corners of the mouth), stomatitis (inflammation of the mouth), and
painful ulcerations of the buccal mucosa and tongue. Gastrointestinal symptoms may be
present and include dysphagia (difficulty swallowing), flatulence, and watery diarrhea.
PTS: 1 REF: Page 989

Question 36

Which diseases are commonly associated with anemia of chronic disease? (Select all that

apply. )
a. Rheumatoid arthritis
b. Acquired immunodeficiency syndrome (AIDS)
c. Polycythemia vera
d. Systemic lupus erythematosus
e. Chronic hepatitis

Answer 36

ANS: A, B, D, E
AIDS, rheumatoid arthritis, systemic lupus erythematosus, malaria, acute and chronic
hepatitis, and chronic renal failure are commonly associated with anemias of chronic
disease. Polycythemia vera is not associated with this form of anemia.
PTS: 1 REF: Page 1001

Question 37

Match the phrases with the corresponding terms. Options may be used more than once.
______ A. Normocytic-normochromic anemia
______ B. Microcytic-hypochromic anemia
______ C. Macrocytic-normochromic anemia

37. Pernicious anemia
38. Sideroblastic anemia
39. Aplastic anemia

Answer 37

37. ANS: C PTS: 1 REF: Pages 987-988
    MSC: Pernicious anemia, a form of macrocytic-normochromic anemia, is caused by vitamin B12
    deficiency.
38. ANS: B PTS: 1 REF: Page 989
    MSC: The microcytic-hypochromic anemias include sideroblastic anemia.
39. ANS: A PTS: 1 REF: Page 993
    MSC: Normocytic-normochromic anemias, including aplastic anemia, are characterized by
    erythrocytes that are relatively normal in size but with hemoglobin content that is insufficient in
    number.