Hematology- Normocytic and Normochromic Anemias

Question 1

1. Hypersplenism is characterized by:
   A. Polycythemia
   B. Pancytosis
   C. Leukopenia
   D. Myelodysplasia

Answer 1

C. Leukopenia

Question 2

2. Which of the following organs is responsible for
   the “pitting process” for RBCs?
   A. Liver
   B. Spleen
   C. Kidney
   D. Lymph nodes

Answer 2

B. Spleen

Question 3

3. Spherocytes differ from normal red cells in all of
   the following except:
   A. Decreased surface to volume
   B. No central pallor
   C. Decreased resistance to hypotonic saline
   D. Increased deformability

Answer 3

D. Increased deformability

Question 4

4. Which of the following is not associated with
   hereditary spherocytosis?
   A. Increased osmotic fragility
   B. An MCHC greater than 36%
   C. Intravascular hemolysis
   D. Extravascular hemolysis

Answer 4

C. Intravascular hemolysis

Question 5

5. Which of the following disorders has an increase
   in osmotic fragility?
   A. Iron deficiency anemia
   B. Hereditary elliptocytosis
   C. Hereditary stomatocytosis
   D. Hereditary spherocytosis

Answer 5

D. Hereditary spherocytosis

Question 6

6. The anemia seen in sickle cell disease is usually:
   A. Microcytic, normochromic
   B. Microcytic, hypochromic
   C. Normocytic, normochromic
   D. Normocytic, hypochromic

Answer 6

C. Normocytic, normochromic

Question 7

7. Which is the major Hgb found in the RBCs of
   patients with sickle cell trait?
   A. Hgb S
   B. Hgb F
   C. Hgb A2
   D. Hgb A

Answer 7

D. Hgb A

Question 8

8. Select the amino acid substitution that is
   responsible for sickle cell anemia.
   A. Lysine is substituted for glutamic acid at the
   sixth position of the α-chain
   B. Valine is substituted for glutamic acid at the
   sixth position of the β-chain
   C. Valine is substituted for glutamic acid at
   the sixth position of the α-chain
   D. Glutamine is substituted for glutamic acid at
   the sixth position of the β-chain

Answer 8

B. Valine is substituted for glutamic acid at the
sixth position of the β-chain

Question 9

9. All of the following are usually found in Hgb C
   disease except:
   A. Hgb C crystals
   B. Target cells
   C. Lysine substituted for glutamic acid at the sixth
   position of the β–chain
   D. Fast mobility of Hgb C at pH 8.6

Answer 9

D. Fast mobility of Hgb C at pH 8.6

Question 10

10. Which of the following hemoglobins migrates to
    the same position as Hgb A2 at pH 8.6?
    A. Hgb H
    B. Hgb F
    C. Hgb C
    D. Hgb S

Answer 10

C. Hgb C

Question 11

11. Which of the following electrophoretic results is
    consistent with a diagnosis of sickle cell trait?

A. Hgb A: 40% Hgb S: 35% Hgb F: 5%
B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%
C. Hgb A: 0% Hgb A2: 5% Hgb F: 95%
D. Hgb A: 80% Hgb S: 10% Hgb A2: 10%

Answer 11

B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%

Question 12

12. In which of the following conditions will
    autosplenectomy most likely occur?
    A. Thalassemia major
    B. Hgb C disease
    C. Hgb SC disease
    D. Sickle cell disease

Answer 12

D. Sickle cell disease

Question 13

13. Which of the following is most true of paroxysmal
    nocturnal hemoglobinuria (PNH)?
    A. It is a rare acquired stem cell disorder that results
    in hemolysis
    B. It is inherited as a sex-linked trait
    C. It is inherited as an autosomal dominant trait
    D. It is inherited as an autosomal recessive trait

Answer 13

A. It is a rare acquired stem cell disorder that results
in hemolysis

Question 14

14. Hemolytic uremic syndrome (HUS) is
    characterized by all of the following except:
    A. Hemorrhage
    B. Thrombocytopenia
    C. Hemoglobinuria
    D. Reticulocytopenia

Answer 14

D. Reticulocytopenia

Question 15

15. An autohemolysis test is positive in all the
    following conditions except:
    A. Glucose-6-phosphate dehydrogenase (G6PD)
    deficiency
    B. Hereditary spherocytosis (HS)
    C. Pyruvate kinase (PK) deficiency
    D. Paroxysmal nocturnal hemoglobinuria (PNH)

Answer 15

D. Paroxysmal nocturnal hemoglobinuria (PNH)

Question 16

16. Which antibody is associated with paroxysmal cold
    hemoglobinuria (PCH)?
    A. Anti-I
    B. Anti-i
    C. Anti-M
    D. Anti-P

Answer 16

D. Anti-P

Question 17

17. All of the following are associated with
    intravascular hemolysis except:
    A. Methemoglobinemia
    B. Hemoglobinuria
    C. Hemoglobinemia
    D. Decreased haptoglobin

Answer 17

A. Methemoglobinemia

Question 18

18. Autoimmune hemolytic anemia is best
    characterized by which of the following?
    A. Increased levels of plasma C3
    B. Spherocytic red cells
    C. Decreased osmotic fragility
    D. Decreased unconjugated bilirubin

Answer 18

B. Spherocytic red cells

Question 19

19. “Bite cells” are usually seen in patients with:
    A. Rh null trait
    B. Chronic granulomatous disease
    C. G6PD deficiency
    D. PK deficiency

Answer 19

C. G6PD deficiency

Question 20

20. The morphological classification of anemias is
    based on which of the following?
    A. M:E (myeloid:erythroid) ratio
    B. Prussian blue stain
    C. RBC indices
    D. Reticulocyte count

Answer 20

C. RBC indices

Question 21

21. Which of the following is a common finding in
    aplastic anemia?
    A. A monoclonal disorder
    B. Tumor infiltration
    C. Peripheral blood pancytopenia
    D. Defective DNA synthesis

Answer 21

C. Peripheral blood pancytopenia

Question 22

22. Congenital dyserythropoietic anemias (CDAs) are
    characterized by:
    A. Bizarre multinucleated erythroblasts
    B. Cytogenetic disorders
    C. Megaloblastic erythropoiesis
    D. An elevated M:E ratio

Answer 22

A. Bizarre multinucleated erythroblasts

Question 23

23. Microangiopathic hemolytic anemia is
    characterized by:
    A. Target cells and Cabot rings
    B. Toxic granulation and Döhle bodies
    C. Pappenheimer bodies and basophilic stippling
    D. Schistocytes and nucleated RBCs

Answer 23

D. Schistocytes and nucleated RBCs

Question 24

24. Which antibiotic(s) is (are) most often implicated
    in the development of aplastic anemia?
    A. Sulfonamides
    B. Penicillin
    C. Tetracycline
    D. Chloramphenicol

Answer 24

D. Chloramphenicol

Question 25

25. Sickle cell disorders are:
    A. Hereditary, intracorpuscular RBC defects
    B. Hereditary, extracorpuscular RBC defects
    C. Acquired, intracorpuscular RBC defects
    D. Acquired, extracorpuscular RBC defects

Answer 25

A. Hereditary, intracorpuscular RBC defects

Question 26

26. Which of the following conditions may produce
    spherocytes in a peripheral smear?
    A. Pelger–Huët anomaly
    B. Pernicious anemia
    C. Autoimmune hemolytic anemia
    D. Sideroblastic anemia

Answer 26

C. Autoimmune hemolytic anemia

Question 27

27. A patient’s peripheral smear reveals numerous
    NRBCs, marked variation of red cell morphology,
    and pronounced polychromasia. In addition to a
    decreased Hgb and decreased Hct values, what
    other CBC parameters may be anticipated?
    A. Reduced platelets
    B. Increased MCHC
    C. Increased MCV
    D. Decreased red-cell distribution width (RDW

Answer 27

C. Increased MCV

Question 28

28. What red cell inclusion may be seen in the
    peripheral blood smear of a patient
    postsplenectomy?
    A. Toxic granulation
    B. Howell–Jolly bodies
    C. Malarial parasites
    D. Siderotic granules

Answer 28

B. Howell–Jolly bodies

Question 29

29. Reticulocytosis usually indicates:
    A. Response to inflammation
    B. Neoplastic process
    C. Aplastic anemia
    D. Red cell regeneration

Answer 29

D. Red cell regeneration

Question 30

30. Hereditary pyropoikilocytosis (HP) is a red cell
    membrane defect characterized by:
    A. Increased pencil-shaped cells
    B. Increased oval macrocytes
    C. Misshapen budding fragmented cells
    D. Bite cells

Answer 30

C. Misshapen budding fragmented cells