Unit4:CH 23 (Porth's 5th ED) Disorders of Red Blood Cells Flashcards
A surgeon is explaining to the parents of a 6-year-old boy the rationale for the
suggestion of removing the boy’s spleen. Which of the following teaching points would
be most accurate?
A) “Ferritin is the activated and usable form of iron that your red blood cells can use
to transport oxygen.”
B) “Ferritin is a stored form of iron that indirectly shows me whether you would
benefit from iron pills.”
C) “Ferritin is a protein–iron complex that allows your red blood cells to make use of
the iron that you consume in your diet.”
D) “Ferritin is the form of iron that is transported in your blood plasma to red blood
cells that need it.”
Ans: B
Feedback:
Ferritin is the protein–iron complex that is stored in tissues, especially the liver, and the
serum levels can be used as an indicator of the need for iron supplements. It is not
accurately characterized as an activated form of iron, nor does it mediate the actual use
of iron by erythrocytes. Transferrin, not ferritin, is transported in plasma, and it is
associated with iron storage.
A 62-year-old female with a diagnosis of acute and chronic renal failure secondary to
diabetes mellitus is receiving her weekly injection of epoetin, a supplementary form of
erythropoietin. Which of the following statements best captures the necessity of this
medication?
A) Erythropoietin is needed in order for stem cells to proliferate into committed
erythroid precursors.
B) Erythropoietin is necessary for the accurate sensation of hypoxia that stimulates
erythropoiesis.
C) Erythropoietin causes the erythrocyte colony–forming units to proliferate and
mature.
D) Erythropoietin facilitates the extrusion of the reticulocyte nucleus and the
formation of true erythrocytes.
Ans: C
Feedback:
Erythropoietin acts primarily in later stages of erythropoiesis to induce the erythrocyte
colony–forming units to proliferate and mature through the normoblast stage into
reticulocytes and mature erythrocytes. It does not act directly on the stem cells, nor does
it play a role in the sensation of hypoxia. Reticulocytes already lack a cell nucleus.
A client with a diagnosis of hemolytic anemia has gone to a community-based
laboratory for follow-up blood work. The lab technician confirms with the client that
hematocrit is one of the components of the blood work. The client replies, “I thought the
point of the blood work was to see how many red blood cells I have today.” How could
the technician best respond to the client’s statement?
A) “This result will tell your care provider about the number of red blood cells in a
given quantity of your blood plasma.”
B) “Your hematocrit measures the average size of your red blood cells and indirectly
measures your oxygen-carrying capacity.”
C) “The result will indicate how many of your red blood cells are new and young and
will indicate your body’s production rate of red cells.”
D) “The hematocrit measures the mass that your red blood cells account for in a
quantity of your blood.”
Ans: D
Feedback:
Hematocrit measures the mass of erythrocytes in a given quantity of blood plasma. It
does not measure the number of red cells, their size, or their production rate and age.
A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level
of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client
possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of
which of the following blood types would be least likely to produce a transfusion
reaction?
A) B–
B) B+
C) A+
D) A–
Ans: D
Feedback:
The client’s blood type is A– and would necessitate A– or O– donor blood. Other types
would induce a transfusion reaction.
Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of
8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a
flushed face, hives over upper body trunk, and is complaining of pain in lower back. His
vital signs include pulse rate of 110 and BP drop to 95/56. What is the nurse’s priority
action?
A) Slow the rate of the blood infusion to 50 mL/hour.
B) Document the assessment as the only action.
C) Discontinue the transfusion and begin an infusion of normal saline.
D) Recheck the type of blood infusing with the chart documentation of patient’s
blood type.
Ans: C
Feedback:
An immediate hemolytic reaction usually is caused by ABO incompatibility. The signs
include flushing of the face, urticaria (hives), headache, pain in the lumbar area, chills,
fever, chest pain, tachycardia, hypotension, and dyspnea. If any of these actions occur,
the transfusion should be stopped immediately. Access to a vein should be maintained
because it may be necessary to infuse IV solutions to ensure diuresis. Slowing the rate
of the blood infusion will not correct this hemolytic reaction and will only worsen the
patient’s condition. Of course, documentation after the above interventions are
performed is vital. Rechecking the blood type infusing will not stop the hemolytic
reaction. After corrective actions/interventions are taken, the blood bag is returned to the
blood bank for further testing.
A 66-year-old female patient has presented to the emergency department because of
several months of intermittently bloody stool that has recently become worse. The
woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of
nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care
team would realize that which of the following situations is most likely to occur?
A) The woman has depleted blood volume due to her ongoing blood loss.
B) She will have iron deficiency anemia due to depletion of iron stores.
C) The patient will be at risk for cardiovascular collapse or shock.
D) She will have delayed reticulocyte release.
Ans: B
Feedback:
Ongoing blood loss is associated with iron deficiency anemia due to the depletion of
iron stores. She is unlikely to have a depleted blood volume or be at risk for shock,
situations more commonly associated with traumatic, sudden blood loss. There would
not likely be a delay in the release of reticulocytes.
Amniocentesis has suggested that a couple’s first child will be born with sickle cell
disease. The parents are unfamiliar with the health problem, and their caregiver is
explaining the complexities. Which of the following statements by the parents would
suggest a need for further teaching or clarification?
A) “Our baby’s red cells are prone to early destruction because of his or her weak
membranes.”
B) “Not all of his or her red cells will be sickled, but low oxygen levels can cause
them to become so.”
C) “Sickled cells can block his or her blood vessels, especially in the abdomen, chest,
and bones.”
D) “Our son or daughter likely won’t show the effects of sickling until he or she is
school-aged because of the different hemoglobin in babies.”
Ans: D
Feedback:
Fetal hemoglobin in the infant is replaced by 8 or 10 weeks of age, and manifestations
of sickle cell disease can begin at this time. Answer choices A, B, and C all convey the
aspects of sickle cell disease.
A child has been diagnosed with thalassemia. Which of the following comorbidities
may occur as a result of having thalassemia?
A) Hypocoagulation
B) Iron deficiency
C) Splenomegaly
D) Neutropeniabb
Ans: C
Feedback:
Thalassemia can result in enlargement of the spleen and liver due to increased
hematopoiesis and red cell destruction. It is associated with thrombotic events, not
hypocoagulation, as well as iron excess. Neutropenia is not associated with thalassemia.
A patient has been diagnosed with anemia. The physician suspects an immune
hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test
will tell the doctor. The nurse replies,
A) “They will wash your RBCs and then mix the cells with a reagent to see if they
clump together.”
B) “They will look at your RBCs under a microscope to see if they have an irregular
shape (poikilocytosis).”
C) “They will be looking to see if you have enough ferritin in your blood.”
D) “They are looking for the presence of antibody or complement on the surface of
the RBC.”
Ans: D
Feedback:
The Coombs test is used to diagnose immune hemolytic anemias. It detects the presence
of antibody or complement on the surface of the red cell. Answer choice A refers to
direct antiglobulin test (DAT). Answer choice B refers to blood smear test. Answer
choice C refers to iron stores test.
A 13-year-old African American boy comes to the ER complaining of fatigue and a
rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy
has grown 2 inches in the previous 5 months. What is the first problem the health care
team would attempt to rule out?
A) Sickle cell anemia
B) Iron deficiency anemia
C) Thalassemia
D) Aplastic anemia
Ans: B
Feedback:
Although each of the above answers is associated with fatigue and rapid heartbeat, male
adolescents are particularly susceptible to iron deficiency anemia. They have high iron
requirements because of growth spurts and dietary deficiencies
A 22-year-old female who adheres to a vegan diet has been diagnosed with iron
deficiency anemia. Which of the following components of her diagnostic blood work
would be most likely to necessitate further investigation?
A) Decreased mean corpuscular volume (MCV)
B) Decreased hemoglobin and hematocrit
C) Microcytic, hypochromic red cells
D) Decreased erythropoietin levels
Ans: D
Feedback:
It would be unusual to note decreased levels of erythropoietin concurrent with a
diagnosis of anemia. Decreased MCV, hematocrit, and hemoglobin are congruent with
the diagnosis, as are microcytic, hypochromic erythrocytes.
A community health nurse is conducting a class on the nutritional component for new
mothers. Which of the following teaching points would be most justified?
A) “Iron supplementation is not necessary provided you are breast-feeding your
infant.”
B) “Be aware that cow’s milk depletes your baby’s supply of iron.”
C) “Your infant needs the same amount of iron as you but has far fewer sources for
obtaining it.”
D) “If you choose to feed your baby with formula, ensure that it is iron fortified.”
Ans: D
Feedback:
Formula and cereals for infants should be iron fortified to preclude iron deficiency
anemia. Breast-feeding does not necessarily mitigate the need for iron supplementation,
and cow’s milk does not deplete existing iron stores but fails to provide sufficient levels
of absorbable iron. Infants and children have significantly higher iron needs than do
adults.
A client with a diagnosis of atrophic gastritis and consequent pernicious anemia is
receiving high oral doses of vitamin B12. Which of the following changes would be most
likely expected by his care provider at the completion of his treatment?
A) Decreased mean corpuscular volume
B) Increased serum bilirubin
C) Increased folic acid level
D) Decreased free heme levels
Ans: A
Feedback:
Increased red cell size is associated with vitamin B12 deficiency, and MCV would
decrease with treatment. Increased bilirubin and folic acid levels would not be
associated with resolution of pernicious anemia, and heme is not normally present or
measured in a free circulatory form.
Two years after chemotherapy and radiation therapy for lung cancer, a 72-year-old
patient notices that he seems to be extremely tired all the time. The physician suspects
the patient may have developed aplastic anemia. The nurse assessing the patient will
likely find which of the following clinical manifestations of aplastic anemia? Select all
that apply.
A) Complaints of weakness and fatigue
B) Small spots of skin hemorrhages over the entire body
C) Excess bleeding from gums and nose
D) Spoon-shaped deformity of the fingernails
E) Hemolysis from renal dialysis treatments.
Ans: A, B, C
Feedback:
The onset of aplastic anemia may be insidious or sudden. The initial presenting
symptoms include weakness, fatigue, and pallor caused by the anemia. Petechiae and
ecchymoses often occur on the skin, and bleeding from the nose, gums, vagina, or GI
tract may occur due to decreased platelet levels. Spoon-shaped deformity of the
fingernails is seen in iron deficiency anemia. Hemolysis and blood loss from renal
dialysis treatments contribute to anemia associated with a deficiency of erythropoietin
(which is normally produced in the kidneys).
Which of the following patients would be most likely to be experiencing an increase in
renal erythropoietin production?
A) A 71-year-old smoker admitted to the hospital with exacerbation of his chronic
obstructive pulmonary disease (COPD)
B) A 70-year-old woman admitted with dehydration secondary to an overdose of her
potassium-wasting diuretic
C) A 68-year-old man with a long-standing diagnosis of polycythemia vera
D) A 21-year-old man with acute blood loss secondary to a motor vehicle accident 3
hours prior
Ans: A
Feedback:
Increases in erythropoietin production are associated with secondary polycythemia, and
not polycythemia vera, a health problem that can be induced by the hypoxia resulting
from smoking and lung disease. Dehydration is associated with relative polycythemia,
and sudden blood loss would not manifest in increased erythropoietin production.
