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Medical Laboratory Science Reviewer: Hypochromic and Microcytic Anemias

  1. The osmotic fragility test result in a patient with thalassemia major would most likely
    A. Increased hemolysis
    B. Decreased hemolysis
    C. Normal resistance to hemolysis
    D. Decreased hemolysis after incubation at 37°C
    Hematology/Correlate clinical and laboratory data/Microscopic morphology/Osmotic
  2. All of the following are characteristic findings in a patient with IDA except:
    A. Microcytic, hypochromic RBC morphology
    B. Decreased serum iron and ferritin levels
    C. Decreased total iron-binding capacity (TIBC)
    D. Increased RBC protoporphyrin
    Hematology/Correlate clinical and laboratory data/Anemia/Iron deficiency/2
  3. IDA may be distinguished from anemia of chronic infection by:
    A. Serum iron level
    B. RBC morphology
    C. RBC indices
    D. TIBC
    Hematology/Evaluate laboratory data to recognize health and disease states/Anemia/3
  4. Which anemia has RBC morphology similar to that seen in IDA?
    A. Sickle cell anemia
    B. Thalassemia syndrome
    C. Pernicious anemia
    D. HS
    Hematology/Correlate laboratory data with other laboratory data to assess test
    results/Anemia/RBC microscopic morphology/2
  5. IDA is characterized by:
    A. Decreased plasma iron, decreased % saturation, increased TIBC
    B. Decreased plasma iron, decreased plasma ferritin, normal RBC porphyrin
    C. Decreased plasma iron, decreased % saturation, decreased TIBC
    D. Decreased plasma iron, increased % saturation, decreased TIBC
    Hematology/Evaluate laboratory data to recognize health and disease states/Anemia/Iron
  6. Storage iron is usually best determined by:
    A. Serum transferrin levels
    B. Hgb values
    C. Myoglobin values
    D. Serum ferritin levels
    Hematology/Apply knowledge of basic laboratory procedures/Iron/1
  7. All of the following are associated with sideroblastic anemia except:
    A. Increased serum iron
    B. Ringed sideroblasts
    C. Hypochromic anemia
    D. Decreased serum ferritin
    Hematology/Evaluate laboratory data to recognize health and disease
  8. What is the basic hematological defect seen in patients with thalassemia major?
    A. DNA synthetic defect
    B. Hgb structure
    C. β-chain synthesis
    D. Hgb phosphorylation
    Hematology/Apply knowledge of fundamental biological
  9. Which of the following is the primary Hgb in patients with thalassemia major?
    A. Hgb D
    B. Hgb A
    C. Hgb C
    D. Hgb F
    Hematology/Correlate clinical and laboratory diseases/Hemoglobin/Hemoglobinopathy/2
  10. A patient has an Hct of 30%, an Hgb of 8 g/dL, and a RBC count of 4.0 × 1012/L. What
    is the morphological classification of this anemia?
    A. Normocytic, normochromic
    B. Macrocytic, hypochromic
    C. Microcytic, hypochromic
    D. Normocytic, hyperchromic
    Hematology/Evaluate laboratory data to recognize health and disease
  11. In which of the following conditions is Hgb A2 elevated?
    A. Hgb H
    B. Hgb SC disease
    C. β-thalassemia minor
    D. Hgb S trait
    Hematology/Correlate laboratory results with disease states/2
  12. Which of the following parameters may be similar for the anemia of inflammation and
    A. Normocytic indices
    B. Decreased serum iron concentration
    C. Ringed sideroblasts
    D. Pappenheimer bodies
    Hematology/Correlate laboratory data to recognize health and disease states/2

Answers key

  1. B Osmotic fragility is decreased because numerous target cells are present and have
    increased surface volume in patients with thalassemia major.
  2. C In IDA, there is an increase in TIBC and in RBC protoporphyrin. Serum iron and
    ferritin levels are decreased. IDA is characterized by a microcytic hypochromic
  3. D In IDA, serum iron and ferritin levels are decreased, and TIBC and RBC
    protoporphyrin are increased. In chronic disease, serum iron and TIBC are both
    decreased because the iron is trapped in reticuloendothelial (RE) cells and is
    unavailable to RBCs for Hgb production.
  4. B Thalassemia and IDA are both classified as microcytic, hypochromic anemias. IDA is
    caused by defective heme synthesis, whereas thalassemia is caused by decreased
    globin chain synthesis.
  5. A IDA is characterized by decreased plasma iron, increased TIBC, decreased %
    saturation, and microcytic, hypochromic anemia. Iron deficiency occurs in three
    phases: iron depletion, iron-deficient erythropoiesis, and IDA.
  6. D Ferritin enters serum from all ferritin-producing tissues and, therefore, is considered a
    good indicator of body storage iron. Because iron stores must be depleted before
    anemia develops, low serum ferritin levels precede the fall in serum iron associated
    with IDA.
  7. D Sideroblastic anemias are a group of disorders characterized by hypochromic anemia,
    ineffective erythropoiesis, an increase in serum and tissue iron, and the presence of
    ringed sideroblasts in bone marrow.
  8. C In thalassemia major, there is little or no production of the β-chain, resulting in
    severely depressed or no synthesis of Hgb A. Severe anemia is seen, along with
    skeletal abnormalities and marked splenomegaly. The patient is usually supported with
    transfusion therapy.
  9. D Patients with thalassemia major are unable to synthesize the β-chain; hence, little or no
    Hgb A is produced. However, γ-chains continue to be synthesized and lead to variable
    elevations of Hgb F in these patients.
  10. C The indices will provide a morphological classification of this anemia. MCV is 75 fL
    (reference range 80–100 fL), MCH is 20 pg (reference range 27–31 pg), and MCHC is
    26.6% (reference range 32%–36%). Therefore, the anemia is microcytic hypochromic.
  11. C Hgb A2 is part of the normal complement of adult Hgb. This Hgb is elevated in β-
    thalassemia minor because the individual with this condition has only one normal β-
    gene; consequently, there is a slight elevation of Hgb A2 and Hgb F.
  12. B Thirty to fifty percent of the individuals with anemia of chronic inflammation
    demonstrate a microcytic hypochromic blood picture, with decrease in serum iron.
    Serum iron is decreased because it is unable to escape from the RE cells to be
    delivered to the NRBCs in bone marrow.

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