Medical Laboratory Science Reviewer: Macrocytic and Normochromic Anemias

1. Which morphological classification is characteristic of megaloblastic anemia?
   A. Normocytic, normochromic
   B. Microcytic, normochromic
   C. Macrocytic, hypochromic
   D. Macrocytic, normochromic
   Hematology/Correlate clinical and laboratory data/Microscopic morphology/RBCs/2
2. Which anemia is characterized by lack of intrinsic factor that prevents B12 absorption?
   A. Tropical sprue
   B. Transcobalamin deficiency
   C. Blind loop syndrome
   D. Pernicious anemia
   Hematology/Evaluate laboratory data to recognize health and disease states/2
3. All of the following are characteristics of megaloblastic anemia except:
   A. Pancytopenia
   B. Elevated reticulocyte count
   C. Hypersegmented neutrophils
   D. Macrocytic erythrocyte indices
   Hematology/Correlate clinical and laboratory data/Anemia/Megaloblastic/2
4. A patient with a vitamin B12 anemia is prescribed a high dosage of folate. Which of the
   following is expected as a result of this treatment?
   A. An improvement in neurological problems
   B. An improvement in hematological abnormalities
   C. No expected improvement
   D. Toxicity of the liver and kidneys
   Hematology/Select course of action/Anemia/Therapy/3
5. Which of the following disorders is associated with ineffective erythropoiesis?
   A. G6PD deficiency
   B. Liver disease
   C. Hgb C disease
   D. Megaloblastic anemia
   Hematology/Evaluate laboratory data to recognize health and disease states/RBC
   physiology/2
6. A 50-year-old patient is suffering from pernicious anemia. Which of the following
   laboratory data are most likely for this patient?
   A. RBC = 2.5 × 1012/L; WBC = 12,500/μL (12.5 × 109/L); PLT = 250,000/μL (250 × 109/L)
   B. RBC = 4.5 × 1012/L; WBC = 6,500/μL (6.5 × 109/L); PLT = 150,000/μL (150 × 109/L)
   C. RBC = 3.0 × 1012/L; WBC = 5,000/μL (5.0 × 109/L); PLT = 750,000/μL (750 × 109/L)
   D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 × 109/L); PLT = 50,000/μL (50 × 109/L)
   Hematology/Correlate clinical and laboratory data/Anemias/2
7. Which of the following may be seen in the peripheral blood smear from a patient with
   obstructive liver disease?
   A. Schistocytes
   B. Macrocytes
   C. Howell–Jolly bodies
   D. Microcytes
   Hematology/Apply principles of basic laboratory procedures/Microscopic morphology/2
8. The macrocytes typically seen in megaloblastic processes are:
   A. Crescent shaped
   B. Teardrop shaped
   C. Oval shaped
   D. Pencil shaped
   Hematology/Apply principles of basic laboratory procedures/Microscopic
   morphology/Differentials/2
9. Which of the following are most characteristic of the RBC indices associated with
   megaloblastic anemias?
   A. MCV 99 fL, MCH 28 pg, MCHC 31%
   B. MCV 62 fL, MCH 27 pg, MCHC 30%
   C. MCV 125 fL, MCH 36 pg, MCHC 34%
   D. MCV 78 fL, MCH 23 pg, MCHC 30%
   Hematology/Correlate clinical and laboratory data/Megaloblastic anemia/2
10. A patient has 80 NRBCs per 100 leukocytes. In addition to increased polychromasia on
    the peripheral blood smear, what other finding may be present on the CBC?
    A. Increased PLTs
    B. Increased MCV
    C. Increased Hct
    D. Increased RBC count
    Hematology/Correlate clinical and laboratory data/Megaloblastic anemia/2

Answers key

1. D Megaloblastic anemia is macrocytic normochromic because there is no defect in Hgb
   synthesis. These anemias comprise a group of asynchronized anemias characterized by
   defective nuclear maturation resulting from defective DNA synthesis. This abnormality
   accounts for the megaloblastic features in bone marrow and macrocytosis in peripheral
   blood.
2. D Pernicious anemia is caused by lack of intrinsic factor, which prevents vitamin B12
   absorption.
3. B Megaloblastic anemias are associated with ineffective erythropoiesis and, therefore, a
   decrease in the reticulocyte count.
4. B Administration of folic acid to a patient with vitamin B12 deficiency will correct the
   hematological abnormalities, but the neurological problems will persist. This helps
   confirm the correct diagnosis of vitamin B12 deficiency.
5. D Ineffective erythropoiesis is caused by destruction of erythroid precursor cells prior to
   their release from bone marrow. Pernicious anemia results from defective DNA
   synthesis; it is suggested that the asynchronous development of RBCs renders them
   more prone to intramedullary destruction.
6. D Patients with pernicious anemia demonstrate pancytopenia with low WBC, PLT, and
   RBC counts. Because this is a megaloblastic process and a DNA maturation defect, all
   cell lines are affected. In bone marrow, this results in abnormally large precursor cells,
   maturation asynchrony, hyperplasia of all cell lines, and a low M:E ratio.
7. B Patients with obstructive liver disease may have macrocytes on their peripheral blood
   smear because of an increased tendency toward deposition of lipid on the surface of
   RBCs. Consequently, the RBCs are larger or more macrocytic than normal RBCs.
8. C Macrocytes in true megaloblastic conditions are oval, as opposed to the round shape of
   macrocytes usually seen in alcoholism and obstructive liver disease.
9. C The RBC indices in a patient with megaloblastic anemia are macrocytic and
   normochromic. The macrocytosis is prominent, with MCV ranging from 100 to 130
   fL.
10. B The patient will have increased MCV. One of the causes of a macrocytic anemia that
    is not megaloblastic is increased reticulocyte count, here noted as increased
    polychromasia. Reticulocytes are polychromatic macrocytes; therefore, MCV is
    slightly increased.