Révision Chap 11-20 (I GAVE UP) Flashcards
Which of the following is characteristic of severe intravascular hemolysis?
A) decreased bilirubin
B) increased hemopexin
C) decreased urobilinogen
D) decreased haptoglobine
C) decreased urobilinogen
A patient with anemia has a RPI of 2,3 with an VGM of 103 fL. What type of anemia does he have
A) macro
B) normo
C) micro
D) maturation defect
A) macro
Which of the following tests will give information about rate of erythrocyte production
A) RPI
B) serum bilirubin
C) serum ferritin
D) MVC
A) RPI (rétic production)
Morphologie of the cells with
VGM 70 fL
CGMH 25 pg
TGMH 30 g/L
Microcytaire hypochrome
Which of the following is a hemolytic anemia that would be classified as an extrinsic defect?
a. Immune hemolytic anemia
b. Anemia caused by a membrane defect
c. Anemia associated with a deficiency of an erythrocyte enzyme
d. Anemia associated with a structurally abnormal hemoglobin that is unstable
a. Immune hemolytic anemia
Which of the following indicates that compensated hemolytic disease is present in a patient with increased erythrocyte destruction?
a. Increased carboxyhemoglobin
b. Decreased hemoglobin
c. Increased hemoglobin
d. Normal hemoglobin
d. Normal hemoglobin
Which of the following is most typically found in hemolytic anemia?
a. Reticulocytopenia
b. Decreased IRF
c. RPI (retic) greater than 2
d. Increased M:E ratio in bone marrow
c. RP1 greater than 2
Upon examination of the stained blood smear from a patient with anemia and jaundice, the laboratory protessional noted many schistocytes. This is an indication of: (Objective 9)
a. an extrinsic defect
b. extravascular hemolysis
c. intravascular hemolysis
d. inherited anemia
c. intravascular hemolysis
The clinical finding common in a patient with hemolytic anemia is:
A) PICA
B) Kidney stones
C) Jaundic
D) lymph node enlargement
C) Jaundic
A patient has anemia, decreased haptoglobin, hemosiderinurea, and hemoglobinuria. The reticulocyte count is 10%. How would you classify his anemia? (Objectives 8, 9)
a. Hypoproliferative
b. Extravascular hemolytic
c. Maturation defect
d. Survival defect
c. Maturation defect
Which of the following is an adaptation to anemia that tends to increase blood flow to tissues?
(Objective 1)
a. Decrease in 2,3-DPG
b. Shallow inspiration
c. Decreased respiratory rate
d. Increased heart rate
d. Increased heart rate
Which of the following findings is characteristic of the bone marrow in a hemolytic anemia?
(Objective 5)
a. Increased M:E ratio
b. Erythroid hyperplasia
c. Increased amount of fat
d. Hypoplasia
b. Erythroid hyperplasia
What is the iron transport protein called? (Objective 3)
a. Ferritin b.
B.Transferrin
c. Hemosiderin
d. Albumin
Transferrin
The term sideropenic is most closely associated with which anemia? (Objective 1)
a. Iron deferency
b. Sideroblastic
c. Lead poisoning
d. Anemia of chronic disease
a. Iron deferency
Microcytic hypochromic erythrocytes are most characteristic of which anemia?
a. Megaloblastic
b. Led poisoning
C. Iron deficiency
d. Anemia of chronic disease
C. Iron deficiency
Anemia(s) characterized by defective heme synthesis includes: (Objective 6)
a. hemochromatosis
b. megaloblastic anemia
c. thalassemia
d. sideroblastic anemia
d. sideroblastic anemia
The most common cause of ID in middle-aged men is: (Objective 6)
a. inadequate iron in the diet
b. cancer
c. prescription drugs
d. chronic bleeding
d. chronic bleeding
Which of the following is most often associated with the presence of Pappenheimer bodies? (Objective 5)
1. Lead poisoning
b. ID
c. Sideroblastic anemia
d. Anemia of chronic disease
c. Sideroblastic anemia
A patient has been previously diagnosed as being heterozygous for hemoglobin D
What is an important identifying characteristic of this hemoglobin variant:
(Objective 7)
a. It migrates with HbS on hemoglobin electrophoresis at alkaline pH.
b. Sickled RBCs are typically observed on smears.
c. Hemoglobin electrophoresis at alkaline pH is needed for its separation from another common variant.
d. It causes severe hemolytie anemia with many target cells in heterozygotes.
a. It migrates with HbS on hemoglobin electrophoresis at alkaline pH.
Which homozygous hemoglobinopathy is most consistent with the following laboratory test results? (Objective 7
Hemoglobin level mildly decreased, MCV decreased, target cells and hypochromi. observed on smear, a large band in the A2 region on alkaline electrophoresis
a. hemoglobin C
b. hemoglobin E
c. hemoglobin B
d. hemoglobin S
c. hemoglobin E
Which of the following is a clinical condition whose associated laboratory findings are seen in children with sickle cell anemia? (Objectives 7, 8)
a. vaso-occlusive crisis denoted by the presence of many sickled RBCs on smear
B. thrombosis denoted by an increase in WBCs and abnormal differential
a. vaso-occlusive crisis denoted by the presence of many sickled RBCs on smear
Which statement best explains current theory on the etiology of aplastic anemia? (Objective 3)
A) An immune mechanism, possibly involving abnormal T-lymphocytes, leads to suppression of hematopoietic stem cells.
B) A deficiency of cytokines, such as erythropoietin, results in hematopoietic stem cells which are incapable of mitosis.
C) Hematopoietic stem cells are crowded out by neoplastic cells invading the bone marrow.
D) The bone marrow microenvironment is damaged and rendered nonsupportive of the growth of hematopoietic stem cells.
A) An immune mechanism, possibly involving abnormal T-lymphocytes, leads to suppression of hematopoietic stem cells.
A 60-year-old patient with a history of severe anemia was found to have a marked decrease in erythrocyte precursors in the bone marrow with no dysplasia. Leukocyte and platelet precursors were normal. Her hemoglobin was 7.4 g/dL, reticulocyte count was decreased, and red cell indices were normal. Erythrocyte morphology was normal. These test results and patient presentation are consistent with which disorder?
A) Aplastic anemia
B) Iron-deficiency anemia
C) Sickle cell disease
D) Pure red cell aplasia
A) aplastic anemia
A 6-year-old child has CBC and bone marrow results consistent with a diagnosis of aplastic anemia. Chromosome fragility was present, and genetic mutations were demonstrated by molecular analysis. Which disorder is most consistent with this scenario? (Objectives 5, 6)
A) Congenital dyserythropoietic anemia
B) Diamond-Blackfan anemia
C) Fanconi anemia
D) Acquired aplastic anemia
C) Fanconi anemia
Which laboratory test result is inconsistent with a diagnosis of aplastic anemia?
A) Bone marrow 50%
B) Granulocyte 0,2 x 103/mcL
C) Platelet 15 x 103/mcL
D) Reticulocyte 0,3%
A) bone marrow 50%
Which statement best describes current research on potential exposure to environmental agents and the development of aplastic anemia?
A) There is no documented association between any environmental factors and development of aplastic anemia.
B) The majority of aplastic anemia cases are not linked to environmental exposures, but links to benzene and radiation exposure and some medications have been reported.
C) Environmental factors associated with development of most cases of aplastic anemia include a wide array of infectious and chemical agents, drugs, and radiation.
D) Only the antibiotic chloramphenicol and radiation exposure are tied to aplastic anemia.
B) The majority of aplastic anemia cases are not linked to environmental exposures, but links to benzene and radiation exposure and some medications have been reported.
What is the typical morphologic classification of erythrocytes in aplastic anemia? (Objective 9)
A) Hypochromic, microcytic
B) Normochromic, normocytic
C) Normochromic, microcytic
D) Hypochromic, macrocytic
B) Normochromic, normocytic
The bone marrow in aplastic anemia is typically: (Objective 8)
A) Hypocellular
B) Hypercellular
C) Dysplastic
D) Normal
A) hypocellular
Which of the following is (are) considered a cause of hypoproliferation in aplastic anemia? (Objective 3)
1.Damage to stem cells
2 .Depletion of stem cells
3 .Inhibition of stem cells
A) 1 only
B) 1 and 2 only
C) 2 and 3 only
D) 1, 2, and 3
D) 1,2 and 3
What term best describes the peripheral blood findings of a person with aplastic anemia? (Objective 9)
A) Pancytopenia
B) Bicytopenia
C) Granulocytopenia only
D) Anemia only
A) Pancytopenia
Diagnostic criteria for aplastic anemia include: (Objective 2)
A) Corrected reticulocyte count of more than 1%
B) Platelet count less than 100 x 103/mcL
C) Granulocyte count less than 0,5 x 103/mcL
D) Bone marrow less than 50% cellular
C) Granulocyte count less than 0,5 x 103/mcL
What next line of testing would you recommend be ordered when a previously healthy adult presents with pancytopenia on a routine automated CBC?
A) Molecular assays for FA mutations
B) Chromosome breakage assay
C) Review of RBC morphology on the peripheral blood smear
D) Bone marrow examination
D) Bone marrow examination
A 70-year-old patient with a recent history of severe anemia, thrombocytopenia, and neutropenia was referred to a hematologist. Further testing revealed a marked decrease in all hematopoietic precursors in the bone marrow with no dysplasia. Pancytopenia and severely low hemoglobin was observed in the peripheral blood. Red cell indices and erythrocyte morphology was normal. These test results and patient presentation are consistent with which disorder?
A) Aplastic anemia
B) Iron-deficiency anemia
C) Anemia of chronic disease
D) Pure red cell aplasia
A) Aplastic anemia
Mr. Garcia is a 68-year-old man who is being evaluated for kidney disease. His blood urea nitrogen (BUN) is 15 mmol/L (reference ). His hemoglobin concentration was found to be 10.9 g/dL. Which statement is the best possible explanation for his hemoglobin concentration? (Objectives 5, 7, 8)
A) He most likely has experienced severe blood loss (hemorrhage) as result of kidney disease.
B) His kidney disease is causing decreases in erythropoietin, red cell survival, iron, and folate, resulting in anemia.
C) Mr. Garcia’s hemoglobin concentration is normal for a male his age and is unrelated to kidney disease.
D) Nothing in the clinical or laboratory data presented explains the hemoglobin and additional testing is required.
B) His kidney disease is causing decreases in erythropoietin, red cell survival, iron, and folate, resulting in anemia.
What are drawbacks to treatment of aplastic anemia with hematopoietic stem cell transplants?
A) This is considered merely supportive therapy and must be continuously administered.
B) Not all patients will respond to this therapy, which is most successful with older patients.
C) Treatment complications and post-transplant mortality are high.
D) This treatment is recommended only for very young children and is not useful for adults.
C) Treatment complications and post-transplant mortality are high.
What confirmatory test should be performed in suspected cases of AA?
A) Serum iron and TIBC
B) Hemoglobin electrophoresis
C) Bone marrow examination
D) Direct antiglobulin test
C) Bone marrow examination
A 3-year-old patient presents with severe normocytic, normochromic anemia. Platelet counts and leukocyte counts are normal. The mother reported that the child has been healthy since birth but recently had a cold. Which of the following laboratory test results would support a diagosis of TEC?
A) Decreased serum erythropoietin (EPO)
B) Normal hemoglobin F level on hemoglobin electrophoresis
C) Abnormal karyotype
D) I antigen on a patients erythrocytes
B) Normal hemoglobin F level on hemoglobin electrophoresis
A bone marrow from an anemic patient that demonstrates a marked erythroid hypoplasia but normal numbers of other cell lineages is most consistent with a diagnosis of:
A) Fanconi anemia
B) aplastic anemia
C) pure red cell aplasia
D) myelophthisic anemia
C) pure red cell aplasia
A male patient with previously diagnosed infectious mononucleosis infection has become suddenly anemic. A possible cause of the anemia is:
A) iron deficiency
B) folic acid deficiency
C) anemia of chronic disease
D) aplastic anemia
D) aplatic anemia
What is the standard treatment for patients with acquired aplastic anemia?
A) Immunosuppressive therapy
B) Bone marrow transplant
C) Administration of growth factors
D) None; treatment typically not needed
A) Immunosuppressive therapy
What is the most prevalent erythrocyte morphology observed in hereditary spherocytosis?
A) Small, spherical erythrocytes with little or no central pallor
B) Spheroidal erythrocytes with sharp irregular projections
C) Fragmented erythrocytes
D) Oval-shaped erythrocytes
A) Small, spherical erythrocytes with little or no central pallor
What erythrocyte membrane disorder has erythrocytes that are thermally unstable and fragment when heated to 45–46°C?
A) Hereditary spherocytosis
B) Hereditary elliptocytosis
C) Hereditary pyropoikilocytosis
D) PNH
C) Hereditary pyropoikilocytosis
Choose the principal screening test for a diagnosis of hereditary spherocytosis.
A) Autohemolysis test
B) Sucrose hemolysis test
C) Thermal stability test
D) Osmotic fragility test
D) Osmotic fragility test
Erythrocyte membrane disorders associated with known skeletal protein defects include all of the following except:
A) hereditary spherocytosis
B) hereditary overhydrated stomatocytosis
C) hereditary elliptocytosis
D) hereditary pyropoikilocytosis
B) hereditary overhydrated stomatocytosis
Which of the following erythrocyte disorders is associated with abnormal membrane permeability?
A) Hereditary elliptocytosis
B) Hereditary dehydrated stomatocytosis
C) PNH
D) HPP
B) Hereditary dehydrated stomatocytosis
Laboratory features associated with hereditary spherocytosis include:
A) spherocytes on the peripheral smear
B) MCHC (CGHMH) more than 36%
C) increased osmotic fragility
D) all of the above
D) all the above
The red blood cells in paroxysmal nocturnal hemoglobinuria (PNH) demonstrate a(n) _____________osmotic fragility test. (Objectives 4, 5)
A) decreased
B) increased
C) normal
D) unpredictable
C) normal
Le test d’auto hémolyse va être élever tho
The osmotic fragility test determines whether a patient’s erythrocytes are osmotically fragile by measuring the amount of hemolysis that occurs:
A) after a patient’s erythrocytes have been incubated for 24 hours in acidified serum
B) when a patient’s erythrocytes are incubated in various concentrations of hypotonic saline
C) when the patient’s erythrocytes are incubated in a sucrose solution
D) hemolysis when the patient’s erythrocytes are incubated in their own serum for 48 hours
B) when a patient’s erythrocytes are incubated in various concentrations of hypotonic saline
Which of the following is the red blood cell membrane protein defect associated with hereditary pyropoikilocytosis?
A) Deficiency of band 3
B) Defective ankyrin protein
C) Mutant spectrin
D) Excess cholesterol
C) mutant spectrin
(Déficience spectrin alpha remplacer par version muté de spectrin)
Which of the following erythrocyte disorders will demonstrate an increased osmotic fragility pattern?
A) Hereditary elliptocytosis and paroxysmal nocturnal hemoglobinuria
B) Hereditary overhydrated stomatocytosis and hereditary spherocytosis
C) Paroxysmal nocturnal hemoglobinuria and hereditary xerocytosis
D) Sickle cell anemia and thalassemia
B) Hereditary overhydrated stomatocytosis and hereditary spherocytosis
The RBC membrane permeability in hereditary overhydrated stomatocytosis is _________, and the cells have a(n) _________osmotic fragility. (Objective 2)
increased; decreased
decreased; increased
increased; increased
decreased; decreased
increased; increased
What are the two main metabolic pathways that erythrocytes use for glucose metabolism?
A) Krebs cycle and glycolytic pathway
B) Hexokinase and Krebs cycle
C) Oxidative phosphorylation and glycolytic pathway
D) Hexosemonophosphate shunt and glycolytic pathway
D) Hexosemonophosphate shunt and glycolytic pathway
The main protective functions of erythrocyte enzymes result from which of the following?
A) Electron transport and cation pumping using ATP
B) Cation pumping using ATP and protection of hemoglobin by reduced glutathione
C) Protection of hemoglobin by reduced glutathione and electron transport
D) Cation pumping and bilirubin production
B) Cation pumping using ATP and protection of hemoglobin by reduced glutathione
In G6PD deficiency, anemia ultimately results from:
A) buildup of 2,3-BPG and poor iron binding
B) inability to maintain enough ATP to pump cations
C) oxidative damage to hemoglobin and splenic removal of erythrocytes
D) membrane protein defects and loss of erythrocyte flexibility
C) oxidative damage to hemoglobin and splenic removal of erythrocytes
Which is the most common erythrocyte enzyme deficiency?
A) Pyruvate kinase
B) Hexokinase
C) Glucose phosphate isomerase
D) Glucose-6-phosphate dehydrogenase
D) Glucose-6-phosphate dehydrogenase
Following a hemolytic episode, which of the following is a common finding in G6PD deficiency?
A) Reticulocytosis
B) Appearance of burr cells on the blood smear
C) Increased haptoglobin
D) Decreased unconjugated bilirubin
A) Reticulocytosis
An abnormal erythrocyte resulting from splenic removal of Heinz bodies in erythrocytes is called: (Objective 7)
A) macrocyte
B) target cell
C) bite cell
D) dacryocyte
C) bite cell
Following a hemolytic episode in a G6PD-deficient individual, a characteristic finding on a blood smear is:
A) increased polychromasia
B) echinocytes
C) Howell-jolly bodies
D) Pappenheimer bodies
A) increased polychromasia
Why should G6PD testing be delayed for an individual following a hemolytic episode?
A) The level of glucose must have time to replenish.
B) Heinz bodies can interfere with the test method.
C) Deficient cells have been selectively destroyed.
D) The patient needs time to build up iron stores.
C) Deficient cells have been selectively destroyed.
An 18-year-old black male was suspected of having G6PD deficiency when he experienced hemolytic anemia after administration of primaquine. An erythrocyte G6PD analysis performed on blood taken 2 days after symptoms appeared was normal. A reticulocyte count revealed 12% reticulocytes at this time. These results suggest that:
A) the patient definitely does not have G6PD deficiency but could have pyruvate kinase deficiency
B) another G6PD test should be done in several months when the reticulocyte count returns to normal
C) leukocytes could be contaminating the sample, giving a false result
D) the patient probably has the G6PD-Mediterranean variant
B) another G6PD test should be done in several months when the reticulocyte count returns to normal
Explain why bite cells are not characteristic of pyruvate kinase deficiency.
A) The spleen removes them as they are formed.
B) The erythrocyte forms a spherocyte as inclusions are removed.
C) Heinz bodies are not formed in pyruvate kinase deficiency.
D) Pyruvate kinase deficiency does not cause abnormal erythrocyte morphology.
C) Heinz bodies are not formed in pyruvate kinase deficiency.
Which lab test is most useful in screening for G6PD deficiency?
A) Fluorescent spot test
B) CBC
C) Reticulocyte count
D) PEP fluorescent test
A) Fluorescent spot test
The characteristic erythrocyte seen in a peripheral blood smear in WAIHA is a(n):
macrocyte
spherocyte
dacrocyte
elliptocyte
Spherocyte
Which of the following might be observed on a peripheral blood smear in cases of cold autoimmune hemolytic anemia?
Helmet cells
Macrocytes
Agglutination
Spherocytes
Agglutination
Which of the following parameters on an automated hematology instrument could be seen in cases of cold agglutinin syndrome (CAS)?
Falsely elevated MCV (VGM)
Falsely elevated RBC count
Falsely decreased MCHC (CGMH)
Falsely decreased hemoglobin
Falsely elevated MCV (VGM)
One purpose of the DAT is to:
A) detect erythrocytes coated with immunoglobulin in vivo
B) detect antibodies in the serum
C) neutralize serum complement
D) prevent agglutination by IgM antibodies
A) detect erythrocytes coated with immunoglobulin in vivo
Intravascular hemolysis is characteristic of which of the following alloantibody situations?
A) Delayed hemolytic transfusion reaction
B) ABO-HDFN
C) Rh-HDFN
D) Acute hemolytic transfusion reaction
D) Acute hemolytic transfusion reaction
Which of the following is not considered to be a condition caused by autoantibodies?
A) PCH
B) CAS
C) Delayed transfusion reaction
D) Drug-induced hemolytic anemia
C) Delayed transfusion reaction
The Donath-Landsteiner antibody is found in which type of hemolytic anemia?
A) Warm autoimmune hemolytic anemia
B) Paroxysmal cold hemoglobinuria
C) Cold autoimmune hemolytic anemia
D) Drug-induced hemolytic anemia
B) Paroxysmal cold hemoglobinuria
The antibody found in PCH is:
A) IgM
B) IgG
C) directed against the Rh antigens
D) directed against the ABO antigens
B) IgG
A patient who received a transfusion 6 days ago is suspected of having a delayed transfusion reaction. Which of the following would not be a characteristic finding?
A) Positive DAT
B) Positive IAT
C) Hemoglobinuria
D) Decreased hemoglobin
C) Hemoglobinuria
Which of the following results is associated with HUS (SHU) and TTP (purpura)?
Increased haptoglobin
Thrombocytopenia
Reticulocytopenia
Decreased LD
Thrombocytopenia
One of the major criteria that distinguishes DIC (CIVD) from other causes of microangiopathic hemolytic anemia is:
the presence of schistocytes
thrombocytopenia
decreased hemoglobin
an abnormal coagulation test
an abnormal coagulation test
A patient who has anemia with an increased reticulocyte count, increased bilirubin, and many schistocytes on the blood smear could have:
A) MAHA (anémie hémolytique microangiopathie)
B) high cholesterol in the blood
C) spur cell anemia
D) immune hemolytic anemia
A) MAHA (anémie hémolytique microangiopathie)
Which of the following organisms does not cause damage of the erythrocyte because of an intraerythrocytic life cycle?
Plasmodium falciparum
Babesia sp.
Bartonella sp.
Clostridium perfringens
Clostridium perfringens
A characteristic finding on a blood smear in MAHA is the presence of:
target cells
spur cells
schistocytes
echinocytes
Schistocytes
All the following are associated with HUS (SHU) except:
thrombocytosis
nucleated RBCs in peripheral blood
schistocytes
reticulocytosis
Trombocytosis
MAHA is most frequently caused by:
A) microcirculatory lesions
B) immune destruction
C) antagonists in the blood
D) plasma lipid abnormalities
A) microcirculatory lesions
MAHA caused by HUS (SHU) is usually seen in which age group?
Children younger than 5 years of age
Females between 20 and 50 years of age
Either sex younger than 50 years of age
Males older than 16 years of age
Children younger than 5 years of age
Laboratory results for a child who had easy bruising, tiredness, difficulty breathing, and decreased urinary output were hemoglobin: 6.5 g/dL; platelets: PT and APTT within normal reference intervals. His mother indicated he had an episode of bloody diarrhea about 2 weeks earlier but it had not recurred. Based on the clinical and limited laboratory
findings, what is the most likely condition? (Objectives 2, 4)
A) TTP
B) Bartonellosis
C) Clostridium sp. infection
D) HUS (SHU)
D) HUS (SHU)
The most likely age group for developing TTP (purpura thrombopénies) is:
female children younger than 1 year
women between 20 and 50 years
either gender younger than 5 years
men older than 16 years
Women between 20 and 50 years old
Which of the following disorders is not characterized by the presence of schistocytes?
March hemoglobinuria
Insertion of a prosthetic valve
Third-degree burns
Malignant hypertension
Third-degree burns
Hemolytic toxins are the major cause of intravascular hemolysis in diseases or conditions caused by which of the following organisms?
Plasmodium falciparum
Babesia sp.
Bartonella bacilliformis
Clostridium perfringens
Clostridium perfringens
