Other Laboratory Tests

Question 1

Other laboratory tests that can assist in establishing the cause of anemia include ______________ (to detect hemoglobinuria or an increase in urobilinogen) with a ________________ (to detect hematuria or hemosiderin) and ____________ (to detect occult blood or intestinal parasites).

Answer 1

routine urinalysis, microscopic examination, analysis of stool

Question 2

Other certain chemistry studies that are useful in establishing the cause of anemia include _________, _______, __________ (to detect excessive hemolysis), and _____________

Answer 2

serum haptoglobin,
lactate dehydrogenase,
unconjugated bilirubin,
renal and hepatic function tests

Question 3

Iron studies (including serum iron, total iron-binding capacity, transferrin saturation, and serum ferritin) are valuable if ______________ and ______________ are present

Answer 3

an inappropriately low reticulocyte count and a microcytic anemia

Question 4

___________ and __________ are helpful in investigating a macrocytic anemia with a low reticulocyte count, whereas a ____________ can differentiate autoimmune hemolytic anemias from other hemolytic anemias

Answer 4

Serum vitamin B12 and serum folate assays; direct antiglobulin test

Question 5

It may be an indication of hereditary spherocytosis

Answer 5

large spleen

Question 6

A stool positive for occult blood may indicate ______________

Answer 6

iron deficiency

Question 7

The first step in the laboratory diagnosis of anemia is detecting its presence by the accurate measurement of the _______, __________, ____________, and ___________

Answer 7

hemoglobin concentration, hematocrit, MCV, and RBC count

Question 8

It is an extremely important tool and is key in the morphologic classification of anemia

Answer 8

MCV

Question 9

They are characterized by an MCV of less than 80 fL with small RBCs

Answer 9

Microcytic anemias

Question 10

It is often associated with hypochromia (increased central pallor in RBCs) and an MCHC of
less than 32 g/dL

Answer 10

Microcytosis

Question 11

Microcytic anemias are caused by conditions that result in reduced________________

Answer 11

hemoglobin synthesis

Question 12

Heme synthesis is diminished in ___________, ____________ (chronic inflammatory states), and ______________________ (sideroblastic anemia, lead poisoning)

Answer 12

iron deficiency, iron sequestration, and defective protoporphyrin synthesis

Question 13

It is insufficient or defective in thalassemia and in Hb E disease.

Answer 13

Globin chain synthesis

Question 14

Iron deficiency is the most common cause of ___________ anemia; the low iron level is insufficient for maintaining normal erythropoiesis.

Answer 14

microcytic

Question 15

They are characterized by an MCV greater than 100 fL with large RBCs (greater than 8 $m in diameter).

Answer 15

Macrocytic anemias

Question 16

Macrocytic anemias arise from conditions that result in ______________ development in bone marrow

Answer 16

megaloblastic or nonmegaloblastic red cell

Question 17

They are caused by conditions that impair synthesis of DNA, such as vitamin B12 and folate deficiency or myelodysplasia.

Answer 17

Megaloblastic anemias

Question 18

______________ lags behind cytoplasmic development as a result of the impaired DNA synthesis.

Answer 18

Nuclear maturation

Question 19

__________ anemia is one cause of vitamin B12 deficiency, whereas ________________ is a leading cause of folate deficiency

Answer 19

Pernicious, pregnancy with increased requirements

Question 20

____________ anemia is characterized by oval macrocytes and hypersegmented neutrophils in the peripheral blood and by megaloblasts or large nucleated erythroid precursors in the bone marrow

Answer 20

Megaloblastic

Question 21

The MCV in megaloblastic anemia can be markedly increased (up to _________ fL), but modest increases (_________fL ) are most common.

Answer 21

150 fL, 100 to 115 fL

Question 22

______________ forms of macrocytic anemias are also characterized by large RBCs, but they are typically related to membrane changes caused by disruption of the cholesterol-to-phospholipid ratio.

Answer 22

Nonmegaloblastic

Question 23

Macrocytic anemias are often seen in patients with ____________, _____________, and ________________

Answer 23

chronic liver disease, alcohol abuse, and bone marrow failure

Question 24

It is rare for the MCV to be greater than __________ fL in nonmegaloblastic anemias.

Answer 24

115 fL

Question 25

_____________ anemias are characterized by an MCV in the range of 80 to 100 fL

Answer 25

Normocytic

Question 26

The RBC morphology on the peripheral blood film must be examined to rule out a dimorphic population of ___________ and _____________ that can yield a normal MCV

Answer 26

microcytes and macrocytes

Question 27

Some normocytic anemias develop as a result of the premature destruction and shortened survival of _______ (hemolytic anemias), and they are characterized by an elevated ___________ count.

Answer 27

RBCs, reticulocyte

Question 28

The hemolytic anemias can be further divided into those that result from ________ causes (membrane defects, hemoglobinopathies, and enzyme deficiencies) and those that result from ___________ causes (immune and nonimmune RBC injury).

Answer 28

intrinsic, extrinsic

Question 29

A ____________ test helps differentiate immune-mediated RBC destruction from other causes of hemolysis.

Answer 29

direct antiglobulin

Question 30

The ______________ is useful in initially classifying anemias into the categories of decreased or ineffective RBC production (decreased reticulocyte count) and excessive RBC loss (increased reticulocyte count).

Answer 30

absolute reticulocyte count

Question 31

When the reticulocyte count is
decreased, the MCV can further classify the anemia into three subgroups: ____________, _______________, and ____________.

Answer 31

normocytic anemias, microcytic anemias, macrocytic anemias

Question 32

The __________ category includes acute
hemorrhage and the hemolytic anemias with shortened RBC survival.

Answer 32

excessive RBC loss