HEMATOLOGY 1

Question 1

Homogenous, continuous, aqueous solution in the cytoplasmic matrix

Answer 1

Cytosol

Question 2

Macromolecular complexes composed of small and large subunit of rRNA and many accessory ribosomal proteins.

Answer 2

Ribosomes

Question 3

are found free in the cytoplasm or on the surface of rough endoplasmic reticulum

Answer 3

Ribosomes

Question 4

serves as the site of protein synthesis

Answer 4

Ribosomes

Question 5

Synthesizes phopholipids and steroids

Answer 5

Smooth endoplasmic reticulum

Question 6

Detoxifies drugs

Answer 6

Smooth endoplasmic reticulum

Question 7

Stores calcium

Answer 7

Smooth endoplasmic reticulum

Question 8

Synthesizes most membrane-bound proteins

Answer 8

Rough endoplasmic reticulum

Question 9

• Term used for the non-mitosis stages of the cell cycle, that is, G1, S, and G2. Mitosis – M phase

Answer 9

Interphase

Question 10

• Two identical daughter cells are produced, each of which receives one entire set of the DNA that was replicated during the S phase

Answer 10

Interphase

Question 11

Interphase
• Duration: _____

Question 12

• Also known as: Gap 1 phase

Answer 12

1. Interphase – G1 phase

Question 13

• Cell grows rapidly and performs its cellular functions

Answer 13

1. Interphase – G1 phase

Question 14

• Period of cell growth and synthesis of components necessary for replication.

Answer 14

1. Interphase – G1 phase

Question 15

1. Interphase – G1 phase
   • Duration: ____

Question 16

• Also known as: Synthesis phase

Answer 16

2. Interphase – S phase

Question 17

• DNA is replicated

Answer 17

2. Interphase – S phase

Question 18

• An exact copy of each chromosome is produced and they pair together as sister chromatids.

Answer 18

2. Interphase – S phase

Question 19

• The centrosome is also duplicated during the S stage.

Answer 19

2. Interphase – S phase

Question 20

2. Interphase – S phase
   • Duration: ____

Question 21

• Also known as: Gap 2 phase

Answer 21

3. Interphase – G2 phase

Question 22

• Period when the cell produces materials essential for cell division

Answer 22

3. Interphase – G2 phase

Question 23

• Tetraploid DNA is checked for proper replication and damage

Answer 23

3. Interphase – G2 phase

Question 24

3. Interphase – G2 phase
   • Duration: ____

Question 25

G0 phase • Also known as: ____________

Question 26

• Cells are not active in cell cycle

Answer 26

G0 phase

Question 27

• Some cells may enter this phase after G1 phase

Answer 27

G0 phase

Question 28

• Normally do not re-enter the cell cycle and remain alive performing their function until apoptosis occurs

Answer 28

G0 phase

Question 29

• Occur at the end of G1 phase

Question 30

• Before DNA replication in S phase

Question 31

• At the end of G2 phase before M phase

Question 32

The chromosomes condense, the duplicated centrosomes begin to separate, and mitotic spindle fibers appear.

Question 33

The nuclear envelope disassembles, the centrosomes move to opposite poles of the cell and serve as a point of origin of the mitotic spindle fibers.

Question 34

The sister chromatids (chromosome pairs) attach to the mitotic spindle fibers.

Question 35

The sister chromatids align on the mitotic spindle fibers at a location equidistant from the centrosome poles.

Question 36

The sister chromatids separate and move on the mitotic spindles toward the centrosomes on opposite poles

Question 37

The nuclear membrane reassembles around each set of chromosomes and the mitotic spindle fibers disappear.

Question 38

The cell divides into two identical daughter cells

Question 39

• Present in small numbers in the bone marrow (<1% cells in the bone marrow)

Answer 39

Stem Cells

Question 40

Types of Human Stem Cells

Answer 40

1. Totipotent hematopoietic stem cell (THSC)
2. Pluripotential or Multipotential stem cell
3. Unipotential Stem cell

Question 41

• These cells are present in the first few hours after an ovum is fertilized.

Answer 41

1. Totipotent hematopoietic stem cell (THSC)

Question 42

• Can develop into any human cell type, including development from embryo into fetus.

Answer 42

1. Totipotent hematopoietic stem cell (THSC)

Question 43

• The most versatile type of stem cell.

Answer 43

1. Totipotent hematopoietic stem cell (THSC)

Question 44

• Give rise to all cell lineage

Answer 44

1. Totipotent hematopoietic stem cell (THSC)

Question 45

• Gives rise to CFU-S and CFU-L

Answer 45

1. Totipotent hematopoietic stem cell (THSC)

Question 46

• Can develop into any human cell type, including development from embryo into fetus.

Answer 46

1. Totipotent hematopoietic stem cell (THSC)

Question 47

• These cells are capable of giving rise to multiple lineages of blood cells

Answer 47

2. Pluripotential or Multipotential stem cell

Question 48

• Example: CFU-S and CFU-L

Answer 48

2. Pluripotential or Multipotential stem cell

Question 49

• Gives rise to single lineage of blood cell Identification

Answer 49

3. Unipotential Stem cell

Question 50

• The identification and origin of stem cells can be determined by

Answer 50

immunophenotypic analysis using flow cytometry

Question 51

Characteristic of stem cell
1. Capable of [?]
2. Give rise to [?]
3. Able to reconstitute the hematopoietic system of a [?]

Answer 51

self-renewal

differentiated progeny

lethally irradiated host

Question 52

Fate of Hematopoietic Stem Cell (HSC)

Answer 52

1. Self-renewal
2. Differentiation
3. Apoptosis

Answer 53

• Glycoprotein
• Encoded on Chromosome 1q
• Stem cell marker

Question 54

General cell size (diameter) ; Nuclear-cytoplasmic ratio

Answer 54

Decreases with maturity

Question 55

Chromatin pattern

Answer 55

Becomes more condensed

Question 56

Presence of nucleoli

Answer 56

Not visible in mature cells

Question 57

Cytoplasmic characteristics: Color

Answer 57

Progresses from darker blue to lighter blue, blue-gray, or pink

Question 58

Cytoplasmic characteristics: Granulation

Answer 58

Progresses from no granules to non-specific to specific granules

Question 59

Cytoplasmic characteristics: Vacuoles

Answer 59

Increase with age

Question 60

• Is a continuous, regulated process of blood cell production that includes cell renewal, proliferation, differentiation, and maturation. (Rodak)

Answer 60

Hematopoiesis

Question 61

• Is a collective term used to describe the process involved in the production of blood cells from human stem cells (HSCs) with subsequent cellular differentiation and development. (Turgeon)

Answer 61

Hematopoiesis

Question 62

• These processes result in the formation, development, and specialization of all of the functional blood cells that are released from the bone marrow to the circulation.

Answer 62

Hematopoiesis

Question 63

• In healthy adults, it is restricted primarily to the bone marrow.

Answer 63

Hematopoiesis

Question 64

• Consists of bone marrow, liver, spleen, lymph nodes, and thymus.

Answer 64

Hematopoiesis

Question 65

• In fetus, hematopoiesis takes place at various intervals in the liver, spleen, thymus, bone marrow, and lymph nodes. At birth, and continuing into adulthood

Answer 65

Hematopoiesis

Question 66

• Takes place in a unique microenvironment in the marrow consisting of stromal cells and extracellular matrix.

Answer 66

Hematopoiesis

Question 67

Hematopoiesis Major locations

Answer 67

• Yolk sac, aorta-gonad-mesonephros (AGM) region, fetal liver, bone marrow, and thymus.

Question 68

• Lymphocytes:

Answer 68

Spleen and lymph nodes of the secondary lymphoid tissues.

Question 69

Hematopoiesis Types

Answer 69

1. P___________________________
2. D___________________________

Question 70

• Occurs during the mesoblastic phase

Question 71

• Begins during the fetal hepatic phase and continuous through adult life

Question 72

Site of hematopoiesis in Adult bone

Question 73

• Large, nucleated cells

Answer 73

Primitive erythrocytes

Question 74

• Contain embryonic hemoglobins: Gower 1, Gower 2 and Portland

Answer 74

Primitive erythrocytes

Question 75

• Occurs in distinct anatomical sites called erythropoietic islands

Answer 75

Erythropoiesis

Question 76

account for 5% to 38% of nucleated cells in normal bone marrow

Answer 76

• Erythroid cells

Question 77

account for 23% to 85% of the nucleated cells in normal bone marrow

Answer 77

• Myeloid cells

Question 78

• Neutrophils in the bone marrow reside in the proliferating pool and the maturation storage pool

Answer 78

Granulopoiesis

Question 79

• Maturing cells spend an average of 3 to 6 days in the proliferating pool

Answer 79

Granulopoiesis

Question 80

• If needed, cells from the storage pool can exit into the circulation rapidly and will have an average life span of 6 to 10 hours.

Answer 80

Granulopoiesis

Question 81

• Unlike other cell lines, lymphocytes and plasma cells are produced in lymphoid follicles.

Answer 81

Lymphopoiesis

Question 82

account for 1% to 5% of the nucleated cells in the normal bone marrow.

Answer 82

• Lymphoid cells

Question 83

• takes place adjacent to the sinus endothelium

Answer 83

Megakaryopoiesis

Question 84

• protrude through the vascular wall as small cytoplasmic processes to deliver platelets into the sinusoidal blood.

Answer 84

Megakaryocytes

Question 85

• develop into platelets in approximately 5 days.

Answer 85

Megakaryocytes

Question 86

START: 19 or 20 day of gestation

Answer 86

1. Mesoblastic Phase

Question 87

END: 8 to 12 week of gestation

Answer 87

1. Mesoblastic Phase

Question 88

Mesodermal cells of the yolk sac and later to aortagonad mesonephros (AGM)

Answer 88

1. Mesoblastic Phase

Question 89

RBCs (Primitive erythroblasts)

Answer 89

1. Mesoblastic Phase

Question 90

START: 5 to 7 gestational week (RODAK) 5 to 6th week of gestation(STEININGER)

Answer 90

2. Hepatic Phase

Question 91

Peak: 3rd month of fetal life (Turgeon)

Answer 91

2. Hepatic Phase

Question 92

END: 1 to 2 weeks after birth

Answer 92

2. Hepatic Phase

Question 93

Main: Liver

Answer 93

2. Hepatic Phase

Question 94

Minor: Spleen, Thymus, Lymph nodes

Answer 94

2. Hepatic Phase

Question 95

RBC, Granulocytes, Monocytes, Megakaryocytes/Platelets

Answer 95

2. Hepatic Phase

Question 96

Stem Cells:

Question 97

Phases of Hematopoiesis:

Question 98

Hematopoietic Hormones:

Question 99

1. Thrombopoietin (TPO) • Also known as ________________________

Question 100

• Synthesized in the liver

Answer 100

1. Thrombopoietin (TPO)

Question 101

• Produced primarily by the kidneys (85 to 90%), and the liver (10 to 15%)

Answer 101

2. Erythropoietin (EPO)

Question 102

• Primary source of erythropoietin in the newborn: liver

Answer 102

2. Erythropoietin (EPO)

Question 103

• Molecular weight: 34,000 Daltons or 34 kD

Answer 103

2. Erythropoietin (EPO)

Question 104

• Produced in the renal peritubular interstitial cells or renal tubular cells

Answer 104

2. Erythropoietin (EPO)

Question 105

• Prevents the apoptosis of erythroid precursors

Answer 105

2. Erythropoietin (EPO)

Question 106

• Induces hemoglobin synthesis and serves as differentiation factor causing the CFU-E to differentiate into Pronormoblasts

Answer 106

2. Erythropoietin (EPO)

Question 107

• First human hematopoietic growth factor to be identified

Answer 107

2. Erythropoietin (EPO)

Question 108

• Encoded on Chromosome 7

Answer 108

2. Erythropoietin (EPO)

Question 109

• Major hematopoietic organ, and a primary lymphoid tissues.

Answer 109

Bone Marrow

Question 110

• One of the body’s largest organs

Answer 110

Bone Marrow

Question 111

• Represents approximately 3.5% to 6% of total body weight

Answer 111

Bone Marrow

Question 112

• Averages 1,500 grams in adults

Answer 112

Bone Marrow

Question 113

Bone Marrow • Predominant cell:

Answer 113

Metamyelocyte (Juvenile)

Question 114

Bone Marrow • Consist of:

Answer 114

Hematopoietic cells (Erythroid, Myeloid, Lymphoid, and Megakaryocyte), Fat (adipose tissue), osteoblasts, osteoclasts, and stroma.

Question 115

• During infancy and early adulthood, all the bones in the body contain primarily red (active) marrow.

Answer 115

Bone Marrow

Question 116

Bone Marrow • Between [?], adipocytes become more abundant and begin to occupy the spaces in the long bones previously dominated by active marrow.

Answer 116

5 and 7 years old

Question 117

• Hematopoietically inactive [?] is scattered throughout the red marrow so that in adults, there is approximately equal amounts of red and yellow marrow in these areas.

Answer 117

yellow marrow

Question 118

is capable of reverting back to active marrow in cases of increased demand on the bone marrow, such as in excessive blood loss or hemolysis.

Answer 118

Yellow marrow

Question 119

Bone Marrow Types:

Answer 119

1. Red Marrow
2. Yellow Marrow

Question 120

• Hematopoietically active marrow

Answer 120

1. Red Marrow

Question 121

• Consists of developing blood cells and their progenitors

Answer 121

1. Red Marrow

Question 122

• By age 18, found only in the vertebrae, ribs, sternum, skull bones, pelvis, proximal epiphyses of femur and humerus.

Answer 122

1. Red Marrow

Question 123

• Hematopoietically inactive marrow

Answer 123

2. Yellow Marrow

Question 124

• Composed primarily of adipocytes (fat cells), with undifferentiated mesenchymal cells and macrophages

Answer 124

2. Yellow Marrow

Question 125

• Under physiological stress, yellow marrow will revert to active red marrow

Answer 125

2. Yellow Marrow

Question 126

• Process of replacing the active marrow by adipocytes (yellow marrow) during development.

Answer 126

Retrogression

Question 127

• Results in restriction of the active marrow in the adult to the sternum, vertebrae, scapulae, pelvis, ribs, skull, proximal portion of the long bones.

Answer 127

Retrogression

Question 128

• In certain abnormal circumstances, the spleen and liver revert back to producing immature blood cells as extramedullary sites. In these cases, enlargement of spleen and liver, hepatosplenomegaly, is frequently noted on physical examination. This situation suggests that undifferentiated primitive blood cells are present in these areas and are able to proliferate if an appropriate stimulus is present.

Answer 128

Extramedullary Hematopoiesis

Question 129

• In certain disease states, the bone marrow is unable to produce sufficient numbers of hematopoietic cells, and the liver and spleen may then become the sites of extramedullary hematopoiesis.

Answer 129

Extramedullary Hematopoiesis

Question 130

• This can occur in hemolytic anemias, where there is increased demand placed on the bone marrow.

Answer 130

Extramedullary Hematopoiesis

Question 131

• However, in cases of aplastic anemia and the leukemias, blood cells are not produced because of the fibrotic nature of the bone marrow or infiltration with malignant cells.

Answer 131

Extramedullary Hematopoiesis

Question 132

Conditions where extramedullary hematopoiesis takes place:

1. When the bone marrow becomes dysfunctional in cases such as aplastic anemia, infiltration by malignant cells, or overproliferation of a cell line (?)
2. When the bone marrow is unable to meet the demands placed on it, as in the [?]

Answer 132

leukemia

hemolytic anemias

Question 133

Other Adult Hematopoietic Tissue:

Question 134

• Main site of hematopoiesis during the Hepatic phase

Answer 134

2. Liver

Question 135

• Main site of production of thrombopoietin (TPO) Liver

Answer 135

2. Liver

Question 136

• is often involved in blood-related diseases.

Answer 136

2. Liver

Question 137

• In porphyrias, hereditary or acquired defects in the enzymes involved in heme biosynthesis result in the accumulation of the various intermediary porphyrins that damage hepatocytes, erythrocyte precursors, and other tissues.

Answer 137

2. Liver

Question 138

• In severe hemolytic anemias, the liver increases the conjugation of bilirubin and the storage of iron.

Answer 138

2. Liver

Question 139

• sequesters membrane-damaged RBCs and removes them from the circulation.

Answer 139

2. Liver

Question 140

• can maintain hematopoietic stem and progenitor cells to produce various blood cells (called extramedullary hematopoiesis) as a response to infectious agents or in pathologic myelofibrosis of the bone marrow.

Answer 140

2. Liver

Question 141

Largest lymphoid organ

Question 142

• Filters the circulating blood

Question 143

• Stores 1/3 of platelet

Question 144

1. Play a role in the formation of new lymphocytes from the germinal centers

Answer 144

4. Lymph Node

Question 145

2. Involved in the processing of specific immunoglobulins

Answer 145

4. Lymph Node

Question 146

3. Filter particulate matter, debris, and bacteria entering the lymph node via the lymph

Answer 146

4. Lymph Node

Question 147

• Maturation site of T-lymphocyte

Answer 147

5. Thymus

Question 148

• First fully developed organ in fetus

Answer 148

5. Thymus

Question 149

• Term used to describe the process of RBC production

Answer 149

Erythropoiesis

Question 150

• Occurs in distinct anatomical sites called erythropoietic islands

Answer 150

Erythropoiesis

Question 151

• Each island consists of a macrophage surrounded by a cluster of erythroblasts.

Answer 151

Erythropoiesis

Question 152

• The macrophage serves to supply the developing red cells with iron for hemoglobin synthesis.

Answer 152

Erythropoiesis

Question 153

• Erythroid cells account for 5% to 38% of nucleated cells in normal bone.

Answer 153

Erythropoiesis

Question 154

• Literally means decrease in oxygen content within the tissues

Question 155

• Produces a dramatic increase in the production of erythropoietin

Question 156

• Primary stimulus for the production of RBCs

Question 157

• Refers to all of the stages of erythrocyte development encompassing the earliest precursor cells in the bone marrow to the mature RBCs in the circulating, peripheral blood and the vascular areas of organs such as the spleen.

Answer 157

Erythron

Question 158

Basic substances needed for normal erythrocyte and hemoglobin production

Answer 158

• Amino acids (protein)
• Iron
• Vitamin B12
• Vitamin B6
• Folic acid (member of B2 complex)
• Trace minerals (Cobalt and nickel)

Question 159

• Produced primarily by the kidneys (80% to 90%), liver (10 to 15%)

Answer 159

Erythropoietin (EPO)

Question 160

• Primary source of EPO in the unborn:

Answer 160

Liver

Question 161

• Site of EPO production in kidneys:

Answer 161

Peritubular cells

Question 162

• Glycoprotein hormone

Answer 162

Erythropoietin (EPO)

Question 163

Erythropoietin (EPO) • MW:

Answer 163

46,000 daltons

Question 164

• First human hematopoietic growth factor to be identified

Answer 164

Erythropoietin (EPO)

Question 165

• Blood levels is inversely related to tissue oxygenation

Answer 165

Erythropoietin (EPO)

Question 166

Erythropoietin (EPO)• Level can increase up to [?] in response to anemia or arterial hypoxemia

Answer 166

20,000 mU/mL

Question 167

: Produces dramatic increase in the production of EPO.

Answer 167

• Tissue hypoxia

Question 168

• prevents erythroid cell apoptosis

Answer 168

Erythropoietin (EPO)

Question 169

Erythropoietin (EPO) General Characteristics of Maturation and Development
• Maturation through nucleated cell stages in [?]
• Bone marrow reticulocytes: [?]
• Reticulocytes in circulation: [?] (represents 0.5% to 1% of the circulating erythrocytes)

Answer 169

4 or 5 days

2.5 days

1 day

Question 170

• One technique used in nuclear medicine to identify sites of erythropoiesis as well as other physiologic characteristics and tumors

Answer 170

Radioactive imaging

Question 171

• After radioisotope injection, total body surface counts are done with an external probe, which shows the location of radioactivity in the body

Answer 171

Radioactive imaging

Question 172

Radioisotopes used

Answer 172

1. Iron-59
2. Iron-52
3. Technetium-99m sulfur colloid

Question 173

• Ingested iron normally is bound to transferrin in the blood, carried to sites of erythrocyte production, and incorporated into the erythrocyte to be used in hemoglobin production

Answer 173

Iron-59 and Iron-52

Question 174

• Has long half-life (45 days), thus exposes the patient to long-term radiation

Answer 174

Iron-59

Question 175

• Does not permit good image production

Answer 175

Iron-59

Question 176

• Has an ideal half-life (8.2 hours)

Answer 176

Iron-52

Question 177

• Excellent for imaging

Answer 177

Iron-52

Question 178

Most widely used radioisotope in clinical imaging

Question 179

• Refers to the total production of red blood cells

Answer 179

Total Erythropoiesis

Question 180

• Production of red blood cells that reach the circulation or peripheral blood

Answer 180

Effective Erythropoiesis (RBCS that reach the circulation)

Question 181

• Uses radioactive 59Fe intravenously to measure rate of disappearance

Answer 181

Plasma Iron turnover

Question 182

• Measures total erythropoiesis

Answer 182

Plasma Iron turnover

Question 183

• Measures effective erythropoiesis

Answer 183

Red cell turnover

Question 184

• Measures 59Fe radioactivity for 2-3 weeks

Answer 184

Red cell turnover

Question 185

Pronormoblast

Answer 185

Proerythroblast Rubriblast

Question 186

Basophilic normoblast

Answer 186

Basophilic erythroblast Prorubricyte

Question 187

Polychromatophilic normoblast or Polychromatic normoblast

Answer 187

Polychromatophilic erythroblast or Polychromatic erythroblast Rubricyte

Question 188

Orthochromic normoblast

Answer 188

Orthochromic erythroblast Metarubricyte

Question 189

Polychromatophilic erythrocyte or Polychromatic erythrocyte/Diffusely Basophilic Erythrocyte or Reticulocyte (Supravital stain)

Erythrocyte

Question 190

• Also known as Rubriblast, Proerythroblast

Question 191

• N:C ratio is 8:1

Question 192

• Fine and uniform chromatin pattern and stains intensely

Question 193

• It takes approximately 3 days for the pronormoblast to develop into the orthochromic normoblast

Question 194

• Earliest recognizable RBC precursor in light microscopy

Question 195

• Also known as Prorubricyte, Basophilic erythroblast

Question 196

• Slightly smaller than rubriblast

Question 197

• N:C ratio is 4:1

Question 198

• Nuclear chromatin becomes more clumped

Question 199

• Last stage with nucleolus

Question 200

• Cytoplasm is less but intensely basophilic (due to RNA)

Question 201

• Also known as Rubricyte, Polychromatophilic erythroblast

Question 202

• Hemoglobin appear for the first time

Question 203

• N:C ratio is 1:1

Question 204

• Muddy, light gray appearance of cell due to variable amounts of pink coloration mixed with basophilia

Question 205

• Last stage capable of mitosis

Question 206

• Also known as Metarubricyte, Orthochromic erythroblast

Question 207

• Nucleus is tightly condensed and described as pyknotic (dense or compact)

Question 208

• In the later period of this stage, the nucleus will be extruded from the cell

Question 209

• Last stage with nucleus

Question 210

• Eight reticulocytes are normally produced from one pronormoblast

Question 211

• Reticulocytes synthesize hemoglobin for approximately 1 day after leaving the marrow

Question 212

• Residual ribosomes, mitochondria, and other organelles are removed in the spleen or are internally dissolved.

Question 213

• Part of this phase occurs in the bone marrow, and the later part of the stage takes place in the circulating blood

Question 214

• Anuclear

Question 215

• In supravital stain: Reticulocyte

Question 216

• Last stage capable of hemoglobin synthesis

Question 217

• After nuclear expulsion, reticulocytes retained in the marrow for 2 to 3 days

Question 218

• Same color with mature RBC

Question 219

• Increased numbers of reticulocytes are prematurely released from the bone marrow under the stimulus of erythropoietin because of such conditions as acute bleeding.

Answer 219

Stress or shift reticulocyte

Question 220

• When stained with a supravital stain, stress reticulocytes exhibit a much denser meshlike network

Answer 220

Stress or shift reticulocyte

Question 221

• An elevated reticulocyte count accompanies a shortened RBC survival

Answer 221

Polychromatophilia, polychromasia, reticulocytosis

Answer 222

6. Mature erythrocyte

Question 223

Earliest recognizable

Question 224

Last stage capable of mitosis

Question 225

Last stage with a nucleolus

Question 226

Last stage with nucleus

Question 227

Last stage that can synthesize hemoglobin

Question 228

• Anaerobic glycolysis

Question 229

• 90 to 95% of ATP

Question 230

• 2 ATP is produced for every glucose molecule broken down to lactic acid

Question 231

• ATP is used to control the flow of sodium and potassium into and out of the RBC, maintain the biconcave shape of the cell, and protect membrane lipids

Question 232

• Important enzyme: Pyruvate kinase

Question 233

• Also known as Pentose phosphate pathway

Question 234

• Decreased activity of an enzyme in this pathway results in oxidized hemoglobin, which denatures and precipitates as Heinz bodies

Question 235

• Important enzymes: G6PD, Glutathione

Question 236

1. Prevent oxidative denaturation of hemoglobin by hydrogen peroxide

Question 237

2. Aerobic glycolysis (5 to 10%)

Question 238

• Maintains the iron present in the hemoglobin molecule in a functional reduced state (Fe2+) for oxygen transport

Question 239

• Enzyme: Methemoglobin reductase or Cytochrome b5 reductase

Question 240

• Allows the production of 2,3 diphosphoglycerate (2,3 DPG)

Question 241

• The 2,3 DPG combines reversibly with the deoxygenated hemoglobin, decreasing the affinity of hemoglobin for oxygen.

Question 242

RBC Membrane • Shape:

Answer 242

Biconcave disk

Question 243

RBC Membrane • Cell membrane:

Answer 243

50% protein, 40% lipid, 10% carbohydrate (BROWN) /52% proteins, 40% lipids, and 8% carbohydrates (RODAK)

Question 244

2 classes of proteins in the membrane

Answer 244

1. Integral/ Transmembrane protein 2. Peripheral/Cytoskeletal/Skeletal protein

Question 245

• In-contact with both the inner and outer surfaces of the membrane

Answer 245

Integral/ Transmembrane protein

Question 246

• Carry various antigens on the membrane surface, while some antigens are also attached to the glycolipid portions of the membrane surface

Answer 246

Integral/ Transmembrane protein

Question 247

• Serve as transport and adhesion sites and signaling receptors

Answer 247

Integral/ Transmembrane protein

Question 248

• Any disruption in transport protein function changes the osmotic tension of the cytoplasm, which leads to a rise in viscosity and loss of deformability

Answer 248

Integral/ Transmembrane protein

Question 249

• Proteins: protein 4.1, ankyrin, and Glycophorin A

Answer 249

Integral/ Transmembrane protein

Question 250

• Responsible of the negative charge of the red blood cell surface

Answer 250

Glycophorin A (M, N antigen)

Question 251

• Proteins: α-spectrin, β-spectrin, and Actin

Answer 251

Peripheral/Cytoskeletal/Skeletal protein

Question 252

• Do not penetrate the bilayer

Answer 252

Peripheral/Cytoskeletal/Skeletal protein

Question 253

= Consists of an α and a β chain in a helix circular pattern like a spring

Answer 253

Peripheral/Cytoskeletal/Skeletal protein • Spectrin

Question 254

= contractile protein that contributes to the deformability of the RBC

Answer 254

Peripheral/Cytoskeletal/Skeletal protein • Actin

Question 255

Variation in shape

Question 256

Variation in size

Question 257

Variation in hemoglobin content

Question 258

• Variation in hemoglobin contents of red blood cells

Question 259

RBC with a normal hemoglobin content have a clear pallor that occupies about 1/3 of the cell diameter

Question 260

Decreased hemoglobin concentration and increase central pallor

Question 261

• Do not have an area of central pallor because of its increased thickness

Question 262

• Seen in spherocytes, sickle cell, Hb CC and Hb SC

Question 263

RBC shift
Shift to the left=
Shift to the right =

Answer 263

Shift to the left= Microcytosis
Shift to the right = Macrocytosis

Question 264

WBC shift
Shift to the left =
Shift to the right =

Answer 264

Shift to the left = Hyposegmented neutrophil
Shift to the right = Hypersegmented neutrophil

Question 265

Oxygen dissociation curve
Shift to the left =
Shift to the right =

Answer 265

Shift to the left = Increased oxygen affinity
Shift to the right = Decreased oxygen affinity

Question 266

• Spherical in shape

Question 267

• Do not have central pallor

Question 268

• Decreased surface membrane area to volume ratio

Question 269

• Increased MCHC

Question 270

• MCHC between 36 and 38 g/dL

Question 271

• Centrally stained area with a thin outer rim of hemoglobin

Question 272

• Increases in cholesterol and phospholipid may be one cause of target cells

Question 273

• Slit-like (rectangular) area of central pallor

Question 274

• Lost the indentation on one side

Question 275

Red blood cell fragments

Question 276

RBC with a single pointed extension resembling a teardrop or pear

Question 277

RBC fragment in shape of a helmet

Question 278

RBC in the shape of a sickle or crescent due to the formation of rod-like polymers of hemoglobin S within the cells

Question 279

Elliptical (cigar-shaped), Oval (egg-shaped) RBC

Question 280

• Crenated red blood cells

Question 281

• Have blunt spicules evenly distributed over the surface of the RBC

Question 282

• RBC with irregularly spaced projections

Question 283

• These spicules vary in width but usually contain a bulbous, rounded end

Question 284

• RBC with membrane folded over

Question 285

• RBC with one or more semicircular portions removed from the cell margin

Question 286

• RBC with just a thin rim of hemoglobin and a large clear central area

Question 287

• RBC with just a thin rim of hemoglobin and a large clear central area

Question 288

“Poker-chip” stacking of RBCs

Question 289

Associated with hemolytic anemia
ABO HDN
Hereditary spherocytosis

Question 290

Liver disease
Hemoglobinopathies (Sickle cell anemia, hemoglobin CC, hemoglobin E, and hemoglobin SC)

Question 291

Acquired stomatocytosis (Liver disease, Alcoholism)
Electrolyte imbalance
Hereditary stomatocytosis
Artifact
Rh deficiency syndrome/Rh null

Question 292

Microangiopathic hemolytic anemia (DIC, TTP, HUS)
Uremia
Severe burns

Question 293

Myelofibrosis
Pernicious anemia
Myeloid metaplasia
Thalassemia

Question 294

Microangiopathic hemolytic anemia

Question 295

Sickle cell anemia
Hemoglobin SC disease

Question 296

Hereditary elliptocytosis or ovalocytosis
Iron deficiency anemia
Thalassemia major
Myelophthisic anemia

Question 297

Uremia
Severe burns
Pyruvate kinase deficiency

Question 298

Neuroacanthocytosis (Abetalipoproteinemia)
Severe liver disease (Spur cell anemia)
Lipid metabolism disorder

Question 299

Hemoglobin C disease
Hemoglobin SC disease

Question 300

G6PD Deficiency

Question 301

Artifact

Question 302

Cold agglutinins

Question 303

Feulgen stain (DNA stain): Positive

Answer 303

Howell-Jolly bodies

Question 304

Small, reddish-blue fragments of nucleus

Answer 304

Howell-Jolly bodies

Question 305

Round, solid-staining, dark-blue to purple inclusions, 1 to 2 mm in size.

Answer 305

Howell-Jolly bodies

Question 306

If present, cells contain only one or two

Answer 306

Howell-Jolly bodies

Question 307

Represent nuclear remnants predominantly composed of DNA (from karyorrhexis or nuclear disintegration

Answer 307

Howell-Jolly bodies

Question 308

Megaloblastic anemia
Alcoholism
Hemolytic anemias
Pernicious anemia
Post-splenectomy
Physiological atrophy of th spleen

Answer 308

Howell-Jolly bodies

Question 309

Reddish-violet, thin ringlike, figure eight, loopshaped appearance

Answer 309

Cabot rings

Question 310

• Megaloblastic anemia
• Lead poisoning

Answer 310

Cabot rings

Question 311

• Small, irregular, dark-staining granules that appear near the periphery of a young RBC

Answer 311

Pappenheimer bodies (Wright stain) / Siderotic granules (Prussian blue)

Question 312

• Resembles basophilic stippling and must be differentiated by Prussian blue stain

Answer 312

Pappenheimer bodies (Wright stain) / Siderotic granules (Prussian blue)

Question 313

• Refractory anemia
• Sideroblastic anemia
• Iron overload (Hemosiderosis, Hemochromatosis)

Answer 313

Pappenheimer bodies (Wright stain) / Siderotic granules (Prussian blue)

Question 314

• Purple-staining granules in the RBC

Answer 314

Basophilic stippling

Question 315

• Composed of RNA Basophilic stippling

Answer 315

Basophilic stippling

Question 316

• Resembles pappenheimer bodies and must be differentiated by Prussian blue stain

Answer 316

Basophilic stippling

Question 317

• Type: Fine or Coarse (Punctuate basophilia)

Answer 317

Basophilic stippling

Question 318

Fine
• Megaloblastic anemia
• Alcoholism
• Thalassemia
Coarse
Lead poisoning

Answer 318

Basophilic stippling

Question 319

Wright stain: Not visible

Answer 319

Heinz bodies

Hemoglobin H

Question 320

• Composed of Hemoglobin

Answer 320

Heinz bodies

Question 321

• Round, refractile inclusions and are attached to RBC membrane

Answer 321

Heinz bodies

Question 322

• Multiple Heinz bodies = Pitted Golf Ball Appearance

Answer 322

Heinz bodies

Question 323

• G6PD deficiency
• Unstable hemoglobin
• Oxidant drug and chemicals
• Favism (Fava beans)
• Acetylphenylhydrazine/ phenylhydrazine

Answer 323

Heinz bodies

Question 324

• Small greenish-blue inclusion bodies

Answer 324

Hemoglobin H

Question 325

• Composed of tetramer of β globin

Answer 325

Hemoglobin H

Question 326

• “Golf ball” appearance of RBCs

Answer 326

Hemoglobin H

Question 327

Hemoglobin H disease

Answer 327

Hemoglobin H

Question 328

Fingerlike or quartzlike crystal of dense hemoglobin protruding from the RBC membrane

Answer 328

Hemoglobin SC

Question 329

Hemoglobin SC disease

Answer 329

Hemoglobin SC

Question 330

Hexagonal crystal of dense hemoglobin

Answer 330

Hemoglobin C

Question 331

Hemoglobin C disease

Answer 331

Hemoglobin C

Question 332

Malarial Pigment: Hemozoin (GREGORIUS)/Hematin (BELIZARIO)

Answer 332

Malarial stippling

Question 333

Malaria

Answer 333

Malarial stippling

Question 334

Maltese cross/ Tetrads

Answer 334

Babesia inclusion

Question 335

Mistaken as Plasmodium falciparum

Answer 335

Babesia inclusion

Question 336

Vector: Hard Tick/Black Legged Tick/Deer Tick/Ixodes scapularis

Answer 336

Babesia inclusion

Question 337

Babesiosis/Piroplasmosis/Malarialike infection

Answer 337

Babesia inclusion

Answer 338

Plasmodium falciparum

Answer 339

Plasmodium ovale

Answer 340

Plasmodium vivax

Answer 341

Plasmodium malariae

Answer 342

Plasmodium falciparum

Answer 343

Plasmodium ovale

Answer 344

Plasmodium vivax

Answer 345

Plasmodium malariae

Question 346

Malignant tertian malaria

Answer 346

Plasmodium falciparum

Question 347

Black water fever (Cerebral malaria)

Answer 347

Plasmodium falciparum

Question 348

Benign tertian malignant

Answer 348

Plasmodium ovale Plasmodium vivax

Question 349

Quartan malaria

Answer 349

Plasmodium malariae

Question 350

• Crescent, banana or sausage shaped Gametocyte

Answer 350

Plasmodium falciparum

Question 351

• Maurer’s dot or Christopher’s dot

Answer 351

Plasmodium falciparum

Question 352

• Applique

Answer 352

Plasmodium falciparum

Question 353

• Most severe malaria

Answer 353

Plasmodium falciparum

Question 354

• James dot/Schuffner’s dot

Answer 354

Plasmodium ovale

Question 355

• RBCs are oval and enlarged

Answer 355

Plasmodium ovale

Question 356

• Malarial relapse

Answer 356

Plasmodium ovale/vivax

Question 357

• Schuffner’s dot

Answer 357

Plasmodium vivax

Question 358

• Enlarged RBC

Answer 358

Plasmodium vivax

Question 359

• Ameboid ring trophozoite

Answer 359

Plasmodium vivax

Question 360

• Ziemann’s dot

Answer 360

Plasmodium malariae

Question 361

• Fruit pie

Answer 361

Plasmodium malariae

Question 362

• Band form trophozoite

Answer 362

Plasmodium malariae

Question 363

Other name

Answer 363

Erythrocyte, Red corpuscle, Red cell, RBC, Discocyte

Question 364

Color (Wright stain)

Question 365

Lifespan

Question 366

Size

Question 367

Thickness

Question 368

Surface area

Question 369

Shape

Question 370

Function

Question 371

Volume (Normocytic)

Question 372

Zeta potential

Question 373

Site of production

Question 374

Site of destruction

Question 375

• As a nonnucleated cell, the mature RBC is unable to generate new proteins, such as enzymes, so as its cellular functions decline, the cell ultimately approaches death

Answer 375

RBC Destruction

Question 376

• The average RBC has sufficient enzyme function to live 120 days.

Answer 376

RBC Destruction

Question 377

• Because RBCs lack mitochondria, they rely on glycolysis for production of ATP

Answer 377

RBC Destruction

Question 378

• The loss of glycolytic enzymes is central to this process of aging, called senescence, which results in phagocytosis by macrophages

Answer 378

RBC Destruction

Question 379

• Macrophage-mediated hemolysis

Answer 379

Extravascular hemolysis

Question 380

• Occurs in the spleen

Answer 380

Extravascular hemolysis

Question 381

• 90% of RBC destroyed

Answer 381

Extravascular hemolysis

Question 382

• Mechanical hemolysis

Answer 382

Intravascular hemolysis

Question 383

• Although most natural RBC deaths occur in the spleen, a small portion of RBCs rupture, normally intravascularly (within the lumen of blood vessels)

Answer 383

Intravascular hemolysis

Question 384

• Extremely damaged cells lyse within the circulation before they reach the liver or spleen

Answer 384

Intravascular hemolysis

Question 385

• 10% of RBC destroyed

Answer 385

Intravascular hemolysis

Question 386

• Removal of senescent(old) and damaged RBC in the spleen

Question 387

• Removal of RBC inclusion bodies in the spleen

Question 388

• Results to the formation of bite cell

Question 389

Hemoglobin • Identified by __________ in 1862

Question 390

• Major function is to transport oxygen to the tissues and carbon dioxide from the tissues to the lungs

Answer 390

Hemoglobin

Question 391

• Composed of 4 subunits, each containing heme and the protein, globin

Answer 391

Hemoglobin

Question 392

• Every heme group is capable of carrying 1 mole of oxygen, therefore each hemoglobin molecule is able to transport 4 mole of oxygen.

Answer 392

Hemoglobin

Question 393

• Conjugated globular protein

Answer 393

Hemoglobin

Question 394

• First protein whose structure was described using x-ray crystallography

Answer 394

Hemoglobin

Question 395

• Main cytoplasmic component of erythrocytes

Answer 395

Hemoglobin

Question 396

Hemoglobin Composition

Answer 396

a. 4 Heme
b. 4 Globin

Question 397

• Consists of protoporphyrin IX and Ferrous iron (Fe2+)

Answer 397

a. 4 Heme

Question 398

• Each heme contains 1 ferrous iron and 4 pyrrole rings

Answer 398

a. 4 Heme

Question 399

• Consist of 2 identical pairs of unlike polypeptide chains, 141 to 146 amino acids each

Answer 399

b. 4 Globin

Question 400

1 gram hemoglobin
• Can carry __________ of oxygen
• Carries ________ iron

Question 401

Secreted by endothelial cells

Answer 401

Nitric oxide

Question 402

• It relaxes the vascular wall smooth muscle and vasodilation

Answer 402

Nitric oxide

Question 403

• Dysfunctional hemoglobins that are unable to transport oxygen

Answer 403

Dyshemoglobins

Question 404

Dyshemoglobins:

Answer 404

• Methemoglobin, sulfhemoglobin, carboxyhemoglobin

Question 405

Hemoglobin Molecular weight

Answer 405

• 64,000 Daltons or 64 kD

Question 406

Molecules for production

Answer 406

1. Amino acid
2. Iron
3. Vitamins: Vitamin B12, Vitamin B6, and Folic acid (member of vitamin B2 complex)
4. Trace Minerals: Cobalt and Nickel Hemoglobin Biosynthesis

Question 407

3. Vitamins:

Answer 407

Vitamin B12, Vitamin B6, and Folic acid (member of vitamin B2 complex)

Question 408

4. Trace Minerals:

Answer 408

Cobalt and Nickel

Question 409

Hemoglobin Biosynthesis
• [?]of the cytoplasmic hemoglobin is synthesized before the nucleus is extruded

Answer 409

65%

Question 410

Hemoglobin Biosynthesis
•[?] is synthesized in the early reticulocyte

Answer 410

35%

Question 411

= Conformation of the hemoglobin molecule in the deoxygenated form

Answer 411

• Tense state

Question 412

= Conformation of the hemoglobin molecule in the oxygenated form

Answer 412

• Relaxed state

Question 413

• Heme pigment found in striated muscle

Answer 413

Myoglobin

Question 414

• 17,000 Daltons

Answer 414

Myoglobin

Question 415

• Requires amino acid, iron, and protoporphyrin IX as raw materials

Answer 415

Myoglobin

Question 416

• Occurs in the M_____________

Answer 416

Heme biosynthesis

Question 417

• Occurs in the R_____________

Answer 417

Globin biosynthesis

Question 418

• Does not begin until the 20th week of prenatal life

Answer 418

Beta globin

Question 419

• Increased in some β-thalassemias and in iron deficiency anemia (Hubbard)

Answer 419

Hemoglobin A2

Question 420

• Minor component of adult hemoglobin on chromatography analysis

Answer 420

Hemoglobin A1c

Question 421

• Hemoglobin with a glucose irreversibly attached

Answer 421

Hemoglobin A1c

Question 422

• Older RBCs have a higher level of HbA1c than young RBCs

Answer 422

Hemoglobin A1c

Question 423

• Blood concentrations of glucose>400 mg/dL significantly increase levels of HbA1c.

Answer 423

Hemoglobin A1c

Question 424

Alpha
Number of Amino Acids:
Chromosome:

Question 425

Zeta
Number of Amino Acids:
Chromosome:

Question 426

Beta
Number of Amino Acids:
Chromosome:

Question 427

Gamma
Number of Amino Acids:
Chromosome:

Question 428

Delta
Number of Amino Acids:
Chromosome:

Question 429

Epsilon
Number of Amino Acids:
Chromosome:

Answer 430

A1

Answer 431

A2

Answer 432

F

Answer 433

Gower-1

Answer 434

Gower-2

Answer 435

Portland

Question 436

> 95%

Answer 436

A1

Question 437

Predominant hemoglobin in adult

Answer 437

A1

Question 438

<3.5%

Answer 438

A2

Answer 439

A2

Question 440

1-2%

Answer 440

F

Question 441

• Predominant hemoglobin during the hepatic phase

Answer 441

F

Question 442

• Predominant hemoglobin in newborn

Answer 442

F

Answer 443

Gower-1

Question 444

Seen only in mesoblastic phase

Answer 444

Gower-1
Gower-2
Portland

Answer 445

Gower-2

Answer 446

Portland

Question 447

Graphically describe the relationship between oxygen content (percent of saturation) and partial pressure of oxygen (pO2)

Answer 447

Oxygen Dissociation Curve

Question 448

• 26.52 or 27 mmHg for whole blood under accepted standard conditions of pH 7.4 and temperature of 37.5oC

Answer 448

P50 value

Question 449

• Represents hemoglobin’s affinity for oxygen and is used to designate the partial pressure of oxygen at which the hemoglobin molecule is 50% saturated with oxygen

Answer 449

P50 value

Question 450

Increased oxygen affinity

Answer 450

Shift to the left

Question 451

Decreased oxygen affinity

Answer 451

Shift to the right

Question 452

Shape of the curve

Question 453

Term for hemoglobin’s affinity for oxygen as influenced by the pH

Answer 453

Bohr effect

Question 454

Decreased carbon dioxide

Answer 454

Haldane effect

Question 455

Factors affecting oxygen dissociation curve

Answer 455

“CADET”

Question 456

1. Carbon dioxide
   • Increased carbon dioxide = Shift to the ________
   • Decreased carbon dioxide = Shift to the ________

Question 457

2. Acidity (pH)
   • Increased pH = Shift to the ________
   • Decreased pH = Shift to the ________

Question 458

3. DPG
   • Increased 2,3 DPG = Shift to the ________
   • Decreased 2,3 DPG = Shift to the ________

Question 459

4. Exercise
   • Increased exercise =

Answer 459

increased acidity (due to lactic acid), increased temperature

Question 460

5. Temperature
   • Increased temperature = Shift to the ________
   • Decreased temperature = Shift to the ________

Question 461

6. Hemoglobin present
   • Hemoglobin F and Hemoglobin Chesapeake = Shift to the ________
   • Hemoglobin Kansas = Shift to the ________

Question 462

= It won’t hold tight, decreased oxygen affinity, loose binding

Answer 462

Shift to the right = Increased CADET

Question 463

= Increased oxygen affinity, tight binding

Answer 463

Shift to the left = Decreased CADET

Question 464

• Hemoglobin in ferrous (Fe2+) form bounded with carbon dioxide

Answer 464

Deoxyhemoglobin

Question 465

• Color of blood: Purplish-red

Answer 465

Deoxyhemoglobin

Question 466

• Hemoglobin bound to oxygen

Answer 466

Oxyhemoglobin

Question 467

• Color of blood: Bright red

Answer 467

Oxyhemoglobin

Question 468

Cherry red

Answer 468

1. Carboxyhemoglobin

Question 469

Chocolate brown

Answer 469

2. Methemoglobin

Question 470

Mauve lavender

Answer 470

3. Sulfhemoglobin

Question 471

Reversible

Answer 471

1. Carboxyhemoglobin 2. Methemoglobin

Question 472

Irreversible

Answer 472

3. Sulfhemoglobin

Question 473

Hemoglobin bounded with carbon monoxide

Answer 473

1. Carboxyhemoglobin

Question 474

Hemoglobin that contains iron in oxidized or ferric (Fe3+) state

Answer 474

2. Methemoglobin

Question 475

Hemoglobin bounded with sulfur

Answer 475

3. Sulfhemoglobin

Question 476

• Carbon monoxide is an insidious by-product of incomplete hydrocarbon combustion, is generated in toxic amounts from fossil fuels

Answer 476

1. Carboxyhemoglobin

Question 477

• Affinity of hemoglobin to carbon monoxide is 200 to 240 times than oxygen

Answer 477

1. Carboxyhemoglobin

Question 478

• Also known as hemiglobin (Hi), ferrihemoglobin, and oxidized hemoglobin

Answer 478

2. Methemoglobin

Question 479

• Cannot transport oxygen

Answer 479

2. Methemoglobin

Question 480

• Cannot transport oxygen

Answer 480

3. Sulfhemoglobin

Question 481

• Once formed, sulfhemoglobin stays in the erythrocyte during its entire 120-day life span.

Answer 481

3. Sulfhemoglobin

Question 482

• Can combine with carbon monoxide to form carboxysulfhemoglobin

Answer 482

3. Sulfhemoglobin

Question 483

• Can be formed by oxidizing drugs such as acetanilid, phenacetin and sulfonamides, in cases of bacteremia with Clostridium welchii, and in enterogenous cyanosis

Answer 483

3. Sulfhemoglobin

Question 484

• In vitro, sulfhemoglobin forms when hydrogen sulfide (H2S) is added to hemoglobin

Answer 484

3. Sulfhemoglobin

Question 485

• Absorption at 620 nm

Answer 485

3. Sulfhemoglobin

Question 486

Succinyl Coenzyme A + Glycine

Answer 486

Pyridoxal phosphate (Vitamin B6) ↓ Delta-Aminolevulinic acid synthetase

Question 487

Delta-Aminolevulinic acid

Answer 487

↓ Delta-Amino levulinic acid dehydrase

Question 488

Porphobilinogen

Answer 488

↓ Uroporphyrinogen III Cosynthetase

Question 489

Uroporphyrinogen III

Answer 489

↓ Uroporphyrinogen Decarboxylase

Question 490

Coproporphyrinogen III

Answer 490

↓ Coproporphyrinogen oxidase

Question 491

Protoporphyrinogen IX

Answer 491

↓ Protoporphyrinogen oxidase

Question 492

Protoporphyrin IX

Answer 492

Fe2+ ↓ Ferrochelatase or heme synthetase Heme molecule

Question 493

• Atom is located in the center of the heme structure and, in the ferrous (Fe2+) state to bind oxygen

Answer 493

Iron

Question 494

• Iron of each heme is directly bonded to a [?] of a histidine side chain.

Answer 494

nitrogen atom

Question 495

• This histidine is known as the [?] and functions to increase the oxygen affinity of the heme ring.

Answer 495

proximal histidine

Question 496

• Most abundant transition metal in the body

Answer 496

Iron

Question 497

• In the duodenum, dietary free iron is reduced to [?] and taken up from the intestinal lumen into the enterocytes by the iron transport protein divalent metal transporter 1 (DMT1)

Answer 497

ferrous iron

Question 498

is instrumental in the uptake of iron by erythropoietic cells as well

Answer 498

• DMT1

Question 499

• Once absorbed, iron may be stored as [?] in the enterocytes or exported into the circulation by another iron transport protein, [?].

Answer 499

ferritin

ferroportin 1 (fpn1)

Question 500

is important as the last step in intestinal iron absorption

Answer 500

• Ferroportin

Question 501

exports iron into plasma from absorptive enterocytes, from macrophages that recycle the iron of senescent RBCs, and from hepatocytes that store iron

Answer 501

• Ferroportin

Question 502

allows macrophages in the liver, spleen, and bone marrow from damaged or senescent RBCs back into the circulation for reuse

Answer 502

• Hepcidin synthesis

Question 503

exports iron into plasma from absorptive enterocytes, from macrophages that recycle the iron, and from hepatocytes that store iron.

Answer 503

• Ferroportin

Question 504

• In the plasma, ferric iron binds to transferrin, which is delivered into cells by binding to transmembrane glycoprotein,[?]

Answer 504

transferrin receptors (TfR)

Question 505

• Functional

Answer 505

Ferrous (Fe2+) iron

Question 506

• Absorbable form in the intestine

Answer 506

Ferrous (Fe2+) iron

Question 507

Non-Functional

Answer 507

Ferric (Fe3+) iron

Question 508

Normal adult iron level
• About [?]
• [?] in circulation, [?] in Ferritin/Hemosiderin

Answer 508

4,000 mg (3 to 4 g)

60%; 40%

Question 509

1 mg Iron

Answer 509

1 mL RBC

Question 510

Storage form of iron

Answer 510

1. Ferritin
2. Hemosiderin

Question 511

• Short-term storage form of iron

Answer 511

1. Ferritin

Question 512

= protein component of ferritin molecule without iron

Answer 512

• Apoferritin

Question 513

• Long-term storage form of iron

Answer 513

2. Hemosiderin

Question 514

• Also known as siderophilin

Answer 514

Transferrin

Question 515

• Carries two atoms of iron in the ferric (Fe3+) state

Answer 515

Transferrin

Question 516

Absorption site in the small intestine

Question 517

• Produced in the liver

Question 518

• Negative regulator of intestinal iron absorption

Question 519

• Suppresses release of iron from macrophage

Question 520

• Has a role in anemia of chronic inflammation

Question 521

• Normal absorption rate of iron

Question 522

• Daily loss of iron in adult (Turgeon)

Question 523

• Total iron in the human body

Question 524

Storage site of iron in the body

Answer 524

1. Liver (major)
2. Bone marrow
3. Spleen

Question 525

• Under normal conditions, red cell production and the circulating red cell mass (RCM) remain at constant level regulated by the erythropoietic mechanism, which functions to meet the body’s oxygen requirement

Answer 525

RBC Abnormalities

Question 526

• If the RCM is excessively either decreased or increased, significant problems occur

Answer 526

RBC Abnormalities

Question 527

RBC Abnormalities Classification

Answer 527

A. Increased RCM ➢ Polycythemia or Erythrocytosis
B. Decreased RCM ➢ Anemia

Question 528

• Other name: Erythrocytosis

Answer 528

Polycythemia

Question 529

• Associated with increased RBC count, hemoglobin, hematocrit

Answer 529

Polycythemia

Question 530

• A hematocrit >52% in men and >50% in women is often used as the diagnostic criterion

Answer 530

Polycythemia

Question 531

• Maybe classified as relative or absolute

Answer 531

Polycythemia

Question 532

• Due to decrease in the fluid (plasma) portion of the blood that gives the appearance of an increased RCM in relation to total blood volume rather than a true increase in RCM

Answer 532

Relative Polycythemia

Question 533

• Actual number of RBC in the blood is not increased, but the number of cells per unit volume of blood is increased

Answer 533

Relative Polycythemia

Question 534

• Not a hematologic disorder

Answer 534

Relative Polycythemia

Question 535

• RCM is normal

Answer 535

Relative Polycythemia

Question 536

Relative Polycythemia Causes

Answer 536

a. Dehydration secondary to diarrhea, vomiting, excessive sweating, increased vascular permeability (burns or anaphylaxis), or the use of diuretics
b. Anxiety and stress
c. Tobacco smoking (Tobacco polycythemia)
d. Gaisbock’s syndrome

Question 537

➢ Also known as Spurious polycythemia or Stress syndrome

Answer 537

Gaisbock’s syndrome

Question 538

➢ Affected individuals are usually middle-aged, overweight men complaining of headaches, dizziness, and fatigue

Answer 538

Gaisbock’s syndrome

Question 539

➢ Associated with smoking, cardiovascular problems, hypertension, and diuretic therapy

Answer 539

Gaisbock’s syndrome

Question 540

• Refers to true increase in RCM and is associated with various causes

Answer 540

Absolute Polycythemia

Question 541

Absolute Polycythemia Classification:

Answer 541

1. Absolute Primary Polycythemia
2. Absolute Secondary Polycythemia

Question 542

• Also known as Polycythemia rubravera/Vaquez Osler disease/Panmyelosis

Answer 542

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 543

• Characterized by uncontrolled proliferation of bone marrow elements

Answer 543

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 544

• A chronic myeloproliferative disorder

Answer 544

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 545

• Absolute increased in RBC, WBC and platelets (Pancytosis)

Answer 545

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 546

• The bone marrow is hypercellular showing an overall increase in granulocytic, erythroid, megakaryocytic cells (Panhyperplasia)

Answer 546

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 547

• Results to 2 to 3 times increased in blood volume

Answer 547

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 548

• Blood is very viscous due to increased RBCs

Answer 548

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 549

• Erythrocyte sedimentation rate(ESR) is decreased

Answer 549

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 550

• Erythropoietin is decreased

Answer 550

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 551

• Leukocyte alkaline phosphatase is increased

Answer 551

Absolute Primary Polycythemia - Polycythemia vera (PV)

Question 552

• Due to increased level of erythropoietin(EPO) in the blood

Answer 552

Absolute Secondary Polycythemia

Question 553

• This may occur as a normal response to hypoxia or as a result of inappropriate EPO production

Answer 553

Absolute Secondary Polycythemia

Question 554

• This may occur as a normal response to hypoxia or as a result of inappropriate EPO production

Answer 554

Absolute Secondary Polycythemia

Question 555

Absolute Secondary Polycythemia Causes:

Answer 555

1. Residence at high altitudes
2. Chronic pulmonary disease
3. Chronic congestive heart failure
4. Heavy smoking
5. Methemoglobinemia

Question 556

Chronic effects of smoking

Answer 556

• Increased RBC count, WBC count, MCV and Hemoglobin

Question 557

• A decrease in RBCs, hemoglobin, and hematocrit below the reference range for healthy individuals of the same age, sex, and race, under similar environmental conditions

Answer 557

Anemia

Question 558

• Mild anemic states of cause no symptoms because of the body’s ability to compensate

Answer 558

Anemia

Question 559

is the term for marrow erythroid proliferative activity

Answer 559

• Erythropoiesis

Question 560

• Normal erythropoiesis occurs in the

Answer 560

bone marrow

Question 561

• When[?] is effective, the bone marrow is able to produce the functional RBCs that leave the marrow and supply the peripheral circulation with adequate numbers of cells

Answer 561

erythropoiesis

Question 562

• Production may be impaired due to:

Answer 562

1. Ineffective erythropoiesis 2. Insufficient erythropoiesis

Question 563

• Refers to the production of erythroid progenitor cells that are defective

Answer 563

1. Ineffective erythropoiesis

Question 564

• The defective progenitors are often destroyed in the bone marrow before their maturation and release into the peripheral circulation

Answer 564

1. Ineffective erythropoiesis

Question 565

• The effective production rate is considerably less than the total production rate, which results in a decreased number of normal circulating RBCs

Answer 565

1. Ineffective erythropoiesis

Question 566

1. Ineffective erythropoiesis Condition : “SMT” S______________________
   M______________________
   T______________________

Question 567

• Refers to a decrease in the number of erythroid precursors in the bone marrow, resulting in decreased RBC production and anemia

Answer 567

2. Insufficient erythropoiesis

Question 568

• Anemia can develop as a result of [?] (such as traumatic injury) or premature hemolysis in a shortened RBC life span

Answer 568

acute blood loss

Question 569

• With [?] and excessive hemolysis, the bone marrow is able to increase production of RBCs, but the level of response is inadequate to compensate for the excessive RBC loss

Answer 569

acute blood loss

Question 570

B. Destruction and Loss Causes:

Answer 570

a. Intrinsic defects in the RBC membrane, enzyme, or hemoglobin
b. Extrinsic causes such as antibody-mediated processes, mechanical fragmentation, or infection related

Question 571

Test for Accelerated RBC Destruction

Answer 571

Lactate dehydrogenase
Indirect bilirubin
Glycated hemoglobin
Chromium radioisotope

Question 572

Enzyme that is release into the blood upon hemolysis

Answer 572

Lactate dehydrogenase

Question 573

Also known as B1

Answer 573

Indirect bilirubin

Question 574

• Also known as Hemoglobin A1C

Answer 574

Glycated hemoglobin

Question 575

• Increases over the life of the cell as it is exposed to plasma glucose

Answer 575

Glycated hemoglobin

Question 576

• Decreased in chronic hemolytic disease the cells have less exposure to plasma glucose before lysis

Answer 576

Glycated hemoglobin

Question 577

Reference method for RBC survival studies by International Committee for Standardization in Hematology (ICSH)

Answer 577

Chromium radioisotope

Question 578

Laboratory Diagnosis of Anemia

Answer 578

Complete blood count(CBC) and RBC Indices
Peripheral blood film examination
Bone marrow examination
Hemoglobin and Hematocrit

Question 579

Complete blood count(CBC) and RBC Indices

Answer 579

1. RBC count
2. H and H (Hematocrit and Hemoglobin)
3. RBC indices (MCV, MCH, MCHC)
4. WBC count
5. Platelet count
6. Red cell distribution width (RDW)
7. Relative and absolute reticulocyte count

Question 580

• Obtain from automated analyzers

Answer 580

6. Red cell distribution width (RDW)

Question 581

• Indicates variation in size (Anisocytosis)

Answer 581

6. Red cell distribution width (RDW)

Question 582

• Should be done when anemia is found

Answer 582

7. Relative and absolute reticulocyte count

Question 583

• Serves as an important tool to assess the bone marrow’s ability to increase RBC production in response to the anemia

Answer 583

7. Relative and absolute reticulocyte count

Question 584

• Should examine RBC diameter, shape, color, and inclusions

Answer 584

Peripheral blood film examination

Question 585

• Indicated for a patient with an unexplained anemia associated with or without other cytopenia, fever of unknown origin, or suspected hematologic malignancy

Answer 585

Bone marrow examination

Question 586

• Widely used tests for anemia

Answer 586

Hemoglobin and Hematocrit

Question 587

Morphologic Classification of Anemia

Answer 587

Normocytic normochromic
Microcytic normochromic
Microcytic hypochromic
Macrocytic normochromic
Macrocytic hypochromic

Question 588

• Blood picture shows red cells that are normal in size and normal in hemogobin contents

Answer 588

Normocytic normochromic

Question 589

• Normal MCV, MCH, MCHC

Answer 589

Normocytic normochromic

Question 590

• Condition: Hemodilution, hemorrhage, hemolytic anemia, and aplastic anemia

Answer 590

Normocytic normochromic

Question 591

• Blood picture shows small red cells with normal hemoglobin contents

Answer 591

Microcytic normochromic

Question 592

• Normal MCHC

Answer 592

Microcytic normochromic

Question 593

• Decreased MCV and MCH

Answer 593

Microcytic normochromic

Question 594

• Condition: Chronic inflammations

Answer 594

Microcytic normochromic

Question 595

• Blood picture shows small red cells that are pale in color due to decreased hemoglobin contents

Answer 595

Microcytic hypochromic

Question 596

• Decreased MCV, MCH, MCHC

Answer 596

Microcytic hypochromic

Question 597

• Condition: Thalassemia, and severe iron deficiency anemia

Answer 597

Microcytic hypochromic

Question 598

• Blood picture shows red cells that are larger than normal

Answer 598

Macrocytic normochromic

Question 599

• Although they contain a larger than normal weight of hemoglobin, the MCHC is normal so that the cells therefore, are normochromic

Answer 599

Macrocytic normochromic

Question 600

• Increased MCV, MCH

Answer 600

Macrocytic normochromic

Question 601

• Normal MCHC

Answer 601

Macrocytic normochromic

Question 602

• Condition: Pernicious anemia

Answer 602

Macrocytic normochromic

Question 603

• Blood picture shows red cells that are larger than normal but are hypochromic due to decreased MCHC.

Answer 603

Macrocytic hypochromic

Question 604

• Increased MCV

Answer 604

Macrocytic hypochromic

Question 605

• Decreased MCH and MCHC

Answer 605

Macrocytic hypochromic

Question 606

Anemia of Bone Marrow Failure

Answer 606

Aplastic anemia

Question 607

Hereditary Aplastic Anemia

Answer 607

Fanconi Anemia (FA)

Diamond-Blackfan Anemia (DBA)

Question 608

Acquired Aplastic Anemia

Answer 608

Myelophthisic anemia

Anemia of Chronic Kidney Disease (CKD)

Question 609

• Is a condition in which there is a peripheral blood pancytopenia

Answer 609

Aplastic anemia

Question 610

• Pancytopenia is a decrease in all blood cells (RBC, WBC, Platelet)

Answer 610

Aplastic anemia

Question 611

• ↓ Reticulocytes

Answer 611

Aplastic anemia

Question 612

• Lymphocytes are the cells predominant in the peripheral blood because it has a longer life span

Answer 612

Aplastic anemia

Question 613

Aplastic anemia Clinical
• Bleeding =
• Anemia =
• Infection =
• No [?]
• No [?]

Answer 613

↓ platelets

↓ RBCs

↓ WBCs

splenomegaly

lymphadenopathy

Question 614

Anemia of Bone Marrow Failure Causes

Answer 614

• Genetic defect
• Ionizing radiation
• Chemicals
• Viruses (Parvovirus B19)
• Benzene
• Trinitrotoluene
• Insecticides and weed killers
• Chloramphenicol = most common cause
• Inorganic arsenic

Question 615

Anemia of Bone Marrow Failure Types

Answer 615

Hereditary • Fanconi Anemia (FA) • Diamond-Blackfan Anemia (DBA)

Acquired • Myelophthisic anemia • Chronic kidney disease

Question 616

• Also known as Congenital Aplastic Anemia

Answer 616

Fanconi Anemia (FA)

Question 617

• Rare, inherited form of aplastic anemia

Answer 617

Fanconi Anemia (FA)

Question 618

• Inheritance is Autosomal Recessive (AR)

Answer 618

Fanconi Anemia (FA)

Question 619

• Total decreased in RBC, WBC, and platelets in the peripheral blood (Pancytopenia)

Answer 619

Fanconi Anemia (FA)

Question 620

• Type of anemia: Normocytic

Answer 620

Fanconi Anemia (FA)

Diamond-Blackfan Anemia (DBA)

Myelophthisic anemia

Question 621

• Low birth weight <2,500g

Answer 621

Fanconi Anemia (FA)

Question 622

• Skin hyperpigmentation (cafe au lait spots)

Answer 622

Fanconi Anemia (FA)

Question 623

• Short stature

Answer 623

Fanconi Anemia (FA)

Question 624

• Skeletal disorders

Answer 624

Fanconi Anemia (FA)

Question 625

• Renal malformations

Answer 625

Fanconi Anemia (FA)

Question 626

• Microcephaly

Answer 626

Fanconi Anemia (FA)

Question 627

• Hypogonadism

Answer 627

Fanconi Anemia (FA)

Question 628

• Mental retardation

Answer 628

Fanconi Anemia (FA)

Question 629

• Strabismus

Answer 629

Fanconi Anemia (FA)

Question 630

• Also known as Congenital Pure Red Cell Aplasia, Congenital erythroid hypoplasia

Answer 630

Diamond-Blackfan Anemia (DBA)

Question 631

• Defective/reduced CFU-E

Answer 631

Diamond-Blackfan Anemia (DBA)

Question 632

• Rare, congenital disorder

Answer 632

Diamond-Blackfan Anemia (DBA)

Question 633

• Normocytic, normochromic anemia with normal leukocyte and platelet count and a marked decrease in marrow erythroblasts

Answer 633

Diamond-Blackfan Anemia (DBA)

Question 634

• Cause: Congenital mutation in R______________

Answer 634

Diamond-Blackfan Anemia (DBA)

Question 635

• Also known as leukoerythroblastic anemia, leukoerythroblastosis, and myelopathic anemia

Answer 635

Myelophthisic anemia

Question 636

• Common finding in patients with carcinoma

Answer 636

Myelophthisic anemia

Question 637

• Results when the bone marrow is replaced by abnormal cells such as metastatic tumor cells (particularly from lung, breast, and prostate), leukemic cells, fibroblasts, and inflammatory cells (found in miliary tuberculosis and fungal infections)

Answer 637

Myelophthisic anemia

Question 638

• If the infiltration and proliferation of the abnormal cells disrupts the normal bone marrow architecture, premature release of immature cells from the bone marrow occurs

Answer 638

Myelophthisic anemia

Question 639

• Because of the unfavorable bone marrow environment, stem and progenitor cells migrate to the spleen and liver and establish extramedullary hematopoietic sites

Answer 639

Myelophthisic anemia

Question 640

= invasion of abnormal cells

Answer 640

• Myelophthisis

Question 641

• ↓Reticulocyte, Teardrop cell, NRBCs, Immature myeloid cells in the peripheral blood, presence of abnormal cells in the bone marrow

Answer 641

Myelophthisic anemia

Question 642

Anemia is due to inadequate production of erythropoietin by the kidneys

Answer 642

Anemia of Chronic Kidney Disease (CKD) •

Question 643

•• Without erythropoietin, the bone marrow is unable to increase RBC production in response to tissue hypoxia

Answer 643

Anemia of Chronic Kidney Disease (CKD)

Question 644

•• ↓ EPO, presence of Burr cells (Due to uremia)

Answer 644

Anemia of Chronic Kidney Disease (CKD)

Question 645

affects all rapidly dividing cells of the body, including the skin, gastrointestinal tract, and bone marrow

Answer 645

• Impaired DNA synthesis

Question 646

are integral components in DNA synthesis, without normal DNA synthesis, megaloblastic erythropoiesis results

Answer 646

• Vitamin B12 and Folate

Question 647

• Deficiencies of either vitamin impair DNA replication, halt cell division, and increase apoptosis, which results in ineffective erythropoiesis and megaloblastic morphology

Answer 647

• Vitamin B12 and Folate

Question 648

Anemia of Abnormal Nuclear Development MCV:

Answer 648

100 to 150 fL (Usually greater than 120 fL)

Question 649

• The root cause of megaloblastic anemia is impaired DNA synthesis

Answer 649

Megaloblastic anemia

Question 650

• The anemia is named for the very large cells of the bone marrow that develop a distinctive morphology due to a reduction in the number of cell divisions

Answer 650

Megaloblastic anemia

Question 651

• MCH is increased because the hemoglobin content is increased in proportion to cell size

Answer 651

Megaloblastic anemia

Question 652

• MCH is increased because the hemoglobin content is increased in proportion to cell size

Answer 652

Megaloblastic anemia

Question 653

• MCV is increased

Answer 653

Megaloblastic anemia

Question 654

• MCHC is normal

Answer 654

Megaloblastic anemia

Question 655

• As the megaloblastic anemia becomes more severe, the peripheral blood gradually reflects pancytopenia and a decreased reticulocyte count, even though the bone marrow is generally hypercellular, as a result of ineffective erythropoiesis and intramarrow RBC destruction

Answer 655

Megaloblastic anemia

Question 656

Causes of Megaloblastic anemia

Answer 656

1. Vitamin B12 deficiency
2. Folate deficiency
3. Megaloblastoid maturation
4. Other cause

Question 657

Increased LDH and fecal urobilinogen

Answer 657

Hemolytic anemia (intravascular)
Ineffective erythropoiesis (megaloblastic anemia)

Question 658

is produced by microorganisms and certain molds

Answer 658

• Vitamin B12

Question 659

• Its dietary sources include animal protein products such as meat, fish eggs, and milk.

Answer 659

• Vitamin B12

Question 660

• It is not found in vegetables or fruit

Answer 660

• Vitamin B12

Question 661

• The liver stores adequate amount of vitamin B12 for several years if no more is ingested

Answer 661

Vitamin B12 Deficiency

Question 662

• Absorption in the gastrointestinal tract requires several factors

Answer 662

Vitamin B12 Deficiency

Question 663

• Absorption in the gastrointestinal tract requires several factors

Answer 663

Vitamin B12 Deficiency

Question 664

• First, the vitamin must be released from foods by peptic digestion in the stomach, which is facilitated by hydrochloric acid (HCl) released from the gastric parietal cells

Answer 664

Vitamin B12 Deficiency

Question 665

also secrete an important protein called intrinsic factor (IF)

Answer 665

• Parietal cells

Question 666

• In the stomach, intrinsic factor forms a protective complex with vitamin B12 that is transported down the GI tract

Answer 666

Vitamin B12 Deficiency

Question 667

• Upon reaching the ileum, the complex attaches to mucosal receptors, B12 is released from IF and absorption takes place

Answer 667

Vitamin B12 Deficiency

Question 668

Causes of Vitamin B12 deficiency

Answer 668

1. Inadequate intake
2. Increased need
3. Impaired absorption

Question 669

• Patients who are strict vegetarian who do not eat meat, eggs, or dairy products

Answer 669

1. Inadequate intake

Question 670

• Vitamin B12 is essential vitamin for animals, plant cannot synthesize vitamin B12

Answer 670

1. Inadequate intake

Question 671

• Occurs during pregnancy, lactation, and growth

Answer 671

2. Increased need

Question 672

• Vitamin B12 in food is released from food proteins primarily in the acid environment of the stomach, aided by pepsin, and is subsequently bound by a specific salivary protein, haptocorrin (also known as R-binder protein)

Answer 672

3. Impaired absorption

Question 673

• In the small intestine, vitamin B12 is released from haptocorrin by the action of trypsin

Answer 673

3. Impaired absorption

Question 674

• It is then bound by intrinsic factor, produced by the gastric parietal cells

Answer 674

3. Impaired absorption

Question 675

• It is then bound by intrinsic factor, produced by the gastric parietal cells

Answer 675

3. Impaired absorption

Question 676

• Vitamin B12 binding to IF is required for absorption by the ileal cells (enterocytes) that possess receptors for the complex

Answer 676

3. Impaired absorption

Question 677

Causes of impaired absorption:

Answer 677

a. Failure to separate vitamin B12 from food proteins
b. Lack of intrinsic factor

Question 678

Causes of impaired absorption:

Answer 678

a. Failure to separate vitamin B12 from food proteins
b. Lack of intrinsic factor

Question 679

o A condition known as “food-cobalamin malabsorption” is characterized by hypochlorhydria and the resulting inability of the body to release vitamin B12 from food or intestinal transport proteins for subsequent binding to intrinsic factor

Answer 679

a. Failure to separate vitamin B12 from food proteins

Question 680

o Lack of intrinsic factor constitutes a significant cause of impaired vitamin B12 absorption

Answer 680

b. Lack of intrinsic factor

Question 681

constitutes a significant cause of impaired vitamin B12 absorption

Answer 681

b. Lack of intrinsic factor

Question 682

o It is most commonly due to autoimmune disease, as in pernicious anemia, but can also result from the loss of parietal cells with Helicobacter pylori infection, total or partial gastrectomy, or hereditary intrinsic factor deficiency

Answer 682

b. Lack of intrinsic factor

Question 683

o It is most commonly due to autoimmune disease, as in pernicious anemia, but can also result from the loss of parietal cells with Helicobacter pylori infection, total or partial gastrectomy, or hereditary intrinsic factor deficiency

Answer 683

b. Lack of intrinsic factor

Question 684

▪ Autoimmune disorder characterized by impaired absorption of vitamin B12 due to lack of intrinsic factor ▪ Production of antibodies to intrinsic factor and gastric parietal cells

Answer 684

Pernicious anemia

Question 685

▪ Persons older than 60 years of age are at higher risk

Answer 685

Pernicious anemia

Question 686

▪ Persons older than 60 years of age are at higher risk

Answer 686

Pernicious anemia

Question 687

▪ Most common form of vitamin B12 deficiency in adults

Answer 687

Pernicious anemia

Question 688

▪ Most common form of vitamin B12 deficiency in adults

Answer 688

Pernicious anemia

Question 689

▪ More common in people with blood group A

Answer 689

Pernicious anemia

Question 690

▪ More common in people with blood group A

Answer 690

Pernicious anemia

Question 691

▪ Able to split vitamin B12 from intrinsic factor, rendering the vitamin unavailable for host absorption

Answer 691

Diphyllobothrium latum (Broadfish tapeworm) infection

Question 692

▪ Portions of the intestines that are stenotic (narrow) as a result of surgery or inflammation, can become overgrown with intestinal bacteria that compete effectively with the host for available vitamin B12

Answer 692

Blind loops

Question 693

▪ Portions of the intestines that are stenotic (narrow) as a result of surgery or inflammation, can become overgrown with intestinal bacteria that compete effectively with the host for available vitamin B12

Answer 693

Blind loops

Question 694

▪ Portions of the intestines that are stenotic (narrow) as a result of surgery or inflammation, can become overgrown with intestinal bacteria that compete effectively with the host for available vitamin B12

Answer 694

Blind loops

Question 695

▪ It causes vitamin B12 malabsorption

Answer 695

Imerslund-Grasbeck syndrome

Question 696

▪ Malabsorption is not related to IF deficiency or defect

Answer 696

Imerslund-Grasbeck syndrome

Question 697

▪ Inheritance is autosomal recessive (AR)

Answer 697

Imerslund-Grasbeck syndrome

Question 698

▪ Inheritance is autosomal recessive (AR)

Answer 698

Imerslund-Grasbeck syndrome

Question 699

▪ Inheritance is autosomal recessive (AR)

Answer 699

Imerslund-Grasbeck syndrome

Question 700

▪ Inheritance is autosomal recessive (AR)

Answer 700

Imerslund-Grasbeck syndrome

Question 701

Cause: Defect in cubilin/amnionless receptor (Henry’s)

Answer 701

Imerslund-Grasbeck syndrome

Question 702

• Provides a measure of body’s ability to secrete viable IF and absorb orally administered 57Co-labeled B12 in the ileum

Answer 702

Schilling test

Question 703

• Along with the 57Co B12, excessive amounts of unlabeled B12 are administered to the patient to fill all tissue binding sites

Answer 703

Schilling test

Question 704

• Normal absorption of vitamin B12 under such circumstances is reflected by a minimum level of urinary excretion of radiolabeled B12

Answer 704

Schilling test

Question 705

Schilling test Specimen and Patient Requirements
• The patient should fast [?]
• A [?] is begun immediately upon administration of the labeled B12 by mouth

Answer 705

overnight

24-hour urine collection

Question 706

Schilling test Procedure
• A physiologic dose of 57Co-labeled vitamin B12 is given by mouth, followed by a “flushing dose” of unlabeled B12 injected intramuscularly within the next [?]
• The flushing dose is given to saturate the liver and tissue binding sites so that, if the labeled B12 is absorbed it will not be completely bound in B12-depleted tissues and some will be excreted in the [?]
• If results of the initial test are abnormal, the test is repeated [?] later
• In this phase, IF is administered with the 57Co B12, to eliminate IF as a variable and to determine whether provision of IF allows for normal [?]
• The results allow for distinguishing between a deficiency of or a defect in IF and a malabsorption syndrome such as that caused [?]

Answer 706

1 to 2 hours

urine

2 to 3 days

B12 absorption

ileal disease or fish tapeworm

Question 707

Schilling test Interpretation:

1. Phase 1 (Radiolabeled B12 without IF)
   • Urine:
   o >7% of labeled B12 is excreted = __________________________
   o <7% of labeled B12 is excreted = __________________________
2. Phase 2 (Radiolabeled B12 with IF)
   • Urine:
   o >7% of labeled B12 is excreted = __________________________
   o <7% of labeled B12 is excreted = __________________________

Question 708

Sources of Folate

Answer 708

Green leafy vegetables, liver, kidney, whole grain cereals, yeast, and fruits(especially oranges)

Question 709

Cause of Folate deficiency

Answer 709

a. Inadequate intake
b. Increased need
c. Impaired absorption
d. Impaired use due to drugs
e. Excessive loss with renal dialysis
f. Alcohol (It interferes with folate metabolism)