Question 1

Which of the following is found in megaloblastic macrocytosis and not in nonmegaloblastic macrocytosis?

Accepted Answer

A) Decreased WBC count and vitamin B₁₂ levels 
B) Decreased hemoglobin and hematocrit 
C) Normal-to-decreased reticulocyte count 
D) Serum bilirubin increased 
A) Decreased WBC count and vitamin B₁₂ levels 
B) Decreased hemoglobin and hematocrit 
C) Normal-to-decreased reticulocyte count 
D) Serum bilirubin increased

Question 2

Deficiencies in folic acid lead to which of the following?

Accepted Answer

A) Nuclear cytoplasmic asynchrony 
B) Absence of nuclear division 
C) Excessive proliferation of myeloid precursors 
D) Decreased proliferation of erythroid precursors 
A) Nuclear cytoplasmic asynchrony 
B) Absence of nuclear division 
C) Excessive proliferation of myeloid precursors 
D) Decreased proliferation of erythroid precursors

Question 3

Which of the following is found in megaloblastic anemia but not nonmegaloblastic macrocytic anemia?

Accepted Answer

A) Macrocytic erythrocytes 
B) Howell-Jolly bodies 
C) Heniz bodies 
D) Hypochromia 
A) Macrocytic erythrocytes 
B) Howell-Jolly bodies 
C) Heniz bodies 
D) Hypochromia

Question 4

A 5-year-old boy with malformed thumbs and microcephaly has been suffering from prolonged bleeding episodes, extreme fatigue, and persistent repetitive infections.His CBC reveals pancytopenia.Cytogenetic analysis shows increased chromosome breakage with the addition of diepoxybutane.Based on these findings, what is the patient most likely suffering from?

Accepted Answer

A) CDA II 
B) Pure red cell aplasia 
C) Diamond Blackfan anemia 
D) Fanconi's syndrome 
A) CDA II 
B) Pure red cell aplasia 
C) Diamond Blackfan anemia 
D) Fanconi's syndrome

Question 5

Which of the following describe the bone marrow in a patient with Fanconi's syndrome?

Accepted Answer

A) Hypercellular with erythroid hyperplasia 
B) Hypocellular with normal M:E ratio 
C) Normocellular with decreased M:E ratio 
D) Hypocellular with elevated M:E ratio 
A) Hypercellular with erythroid hyperplasia 
B) Hypocellular with normal M:E ratio 
C) Normocellular with decreased M:E ratio 
D) Hypocellular with elevated M:E ratio

Question 6

Acquired chronic pure red cell aplasia is a rare disorder encountered in association with several autoimmune disorders.What does the mechanism appear to be?

Accepted Answer

A) B cell-mediated immunosuppression of neutrophils 
B) T cell-mediated immunosuppression of erythropoiesis 
C) Cytokine-mediated immunosuppression of erythropoiesis 
D) Increased serum erythropoietin 
A) B cell-mediated immunosuppression of neutrophils 
B) T cell-mediated immunosuppression of erythropoiesis 
C) Cytokine-mediated immunosuppression of erythropoiesis 
D) Increased serum erythropoietin

Question 7

How can infection with the Epstein-Barr virus (EBV) lead to aplastic anemia?

Accepted Answer

A) EBV causes defects in precursor cells. 
B) EBV infects stem cells, and an immune response is initiated that destroys the stem cells. 
C) EBV creates immune complexes on the surface of the stem cell that damages it. 
D) Infection with the virus shuts down cytokine production by macrophages. 
A) EBV causes defects in precursor cells. 
B) EBV infects stem cells, and an immune response is initiated that destroys the stem cells. 
C) EBV creates immune complexes on the surface of the stem cell that damages it. 
D) Infection with the virus shuts down cytokine production by macrophages.

Question 8

Pernicious anemia is a disorder characterized by:

Accepted Answer

A) Anti-vitamin B₁₂ antibodies. 
B) Lack of IF. 
C) Improper dietary intake of vitamin B₁₂. 
D) Increased absorption of vitamin B₁₂. 
A) Anti-vitamin B₁₂ antibodies. 
B) Lack of IF. 
C) Improper dietary intake of vitamin B₁₂. 
D) Increased absorption of vitamin B₁₂.

Question 9

A patient taking chloramphenicol is at risk for developing aplastic anemia because of which of the following?

Accepted Answer

A) The drug promotes an immune response against stem cells. 
B) The drug is toxic to the bone marrow. 
C) It results in stem cell resistance to essential cytokines. 
D) It causes decreased cytokine production. 
A) The drug promotes an immune response against stem cells. 
B) The drug is toxic to the bone marrow. 
C) It results in stem cell resistance to essential cytokines. 
D) It causes decreased cytokine production.

Question 10

Macrocytes are often seen in hospitalized alcoholics due to:

Accepted Answer

A) Alcohol toxicity on erythroid precursors. 
B) Stimulated erythropoiesis. 
C) Reticulocytosis. 
D) Iron deficiency. 
A) Alcohol toxicity on erythroid precursors. 
B) Stimulated erythropoiesis. 
C) Reticulocytosis. 
D) Iron deficiency.

Question 11

Use this case to answer the following questions. A 55-year-old male consulted his physician because of weakness, lightheadedness, vertigo, and angina. The patient also complained of sores on his tongue. The physical examination revealed jaundice. The pulse rate was increased, and the spleen and liver were slightly enlarged. The tongue appeared smooth and bright red in color. Family history revealed no clues. Neurological exam revealed quickening of reflex responses. Patient history indicated a total gastrectomy five years ago for stomach cancer and intermittent heart problems that had not required surgery. The physician ordered the following tests:
 $\begin{array}{ll}
\text { TEST } & \text { RESULTS } \
\text { WBC } & 3.1 \times 10^{9} / \mathrm{L} \
\text { RBC } & 2.45 \times 10^{12} / \mathrm{L} \
\text { HGB } & 10.5 \mathrm{gm} / \mathrm{dL} \
\text { HCT } & 29.0 \% \
\text { MCV } & 118 \mathrm{fl} \
\text { MCH } & 42.8 \mathrm{pg} \
\text { MCHC } & 36.2 \mathrm{gm} / \mathrm{dL} \
\text { RDW } & 15.7 \
\text { PLT } & 83 \times 10^{9} / \mathrm{L}\
\text { Differential: }\
\text { Polys } & 49 \% \
\text { Stabs } & 6 \% \
\text { Lymphs } & 30 \% \
\text { Mono } & 8 \% \
\text { Eos } & 5 \% \
\text { Basos } & 2 \%
\end{array}$ 
Peripheral blood: macro-ovalocytes, no hypersegmentation noted.
-What is (are) the most appropriate reflex test(s)?

Accepted Answer

A) Iron studies 
B) Bilirubin 
C) Vitamin B?? and folate levels 
D) Hemoglobin electrophoresis 
A) Iron studies 
B) Bilirubin 
C) Vitamin B?? and folate levels 
D) Hemoglobin electrophoresis

Question 12

Which CDA is characterized by a positive Ham test and a negative sucrose lysis test?

Accepted Answer

A) CDA I 
B) CDA II 
C) CDA III 
D) CDA IV 
A) CDA I 
B) CDA II 
C) CDA III 
D) CDA IV

Question 13

A 3-month-old infant is exhibiting pallor and fatigue.The pediatrician orders a CBC, which displays a low RBC count, H&H, and normal WBC and PLT counts.EPO levels are increased.BM aspirate shows prominent erythroid hypoplasia.Cytogenetic analysis reveals the presence of RPS19 mutation.Based on these findings, what is the patient most likely suffering from?

Accepted Answer

A) CDA II 
B) Pure red cell aplasia 
C) Diamond Blackfan anemia 
D) Fanconi's syndrome 
A) CDA II 
B) Pure red cell aplasia 
C) Diamond Blackfan anemia 
D) Fanconi's syndrome

Question 14

Megaloblastic anemia is most often caused by deficiencies of what two components?

Accepted Answer

A) Iron and transferrin 
B) Ferritin and hemoglobin 
C) Vitamin B₁₂ and folate 
D) Iron and liver disease 
A) Iron and transferrin 
B) Ferritin and hemoglobin 
C) Vitamin B₁₂ and folate 
D) Iron and liver disease

Question 15

The cytopenias associated with MDS are due to:

Accepted Answer

A) Dyshematopoiesis. 
B) Bone marrow replacement. 
C) Hypoplasia of the bone marrow. 
D) Decreased cytokine production. 
A) Dyshematopoiesis. 
B) Bone marrow replacement. 
C) Hypoplasia of the bone marrow. 
D) Decreased cytokine production.

Question 16

Use this case to answer the following questions. A 55-year-old male consulted his physician because of weakness, lightheadedness, vertigo, and angina. The patient also complained of sores on his tongue. The physical examination revealed jaundice. The pulse rate was increased, and the spleen and liver were slightly enlarged. The tongue appeared smooth and bright red in color. Family history revealed no clues. Neurological exam revealed quickening of reflex responses. Patient history indicated a total gastrectomy five years ago for stomach cancer and intermittent heart problems that had not required surgery. The physician ordered the following tests:
 $\begin{array}{ll}
\text { TEST } & \text { RESULTS } \
\text { WBC } & 3.1 \times 10^{9} / \mathrm{L} \
\text { RBC } & 2.45 \times 10^{12} / \mathrm{L} \
\text { HGB } & 10.5 \mathrm{gm} / \mathrm{dL} \
\text { HCT } & 29.0 \% \
\text { MCV } & 118 \mathrm{fl} \
\text { MCH } & 42.8 \mathrm{pg} \
\text { MCHC } & 36.2 \mathrm{gm} / \mathrm{dL} \
\text { RDW } & 15.7 \
\text { PLT } & 83 \times 10^{9} / \mathrm{L}\
\text { Differential: }\
\text { Polys } & 49 \% \
\text { Stabs } & 6 \% \
\text { Lymphs } & 30 \% \
\text { Mono } & 8 \% \
\text { Eos } & 5 \% \
\text { Basos } & 2 \%
\end{array}$ 
Peripheral blood: macro-ovalocytes, no hypersegmentation noted.
-All of the following are expected laboratory findings of PA except:

Accepted Answer

A) Decreased vitamin B?? levels. 
B) Increased MMA in the urine. 
C) Part I of Schilling test = 5%; part II of Schilling test = 10%. 
D) Part I of Schilling test = 2.5%; part II of Schilling test = 2.5%. 
A) Decreased vitamin B?? levels. 
B) Increased MMA in the urine. 
C) Part I of Schilling test = 5%; part II of Schilling test = 10%. 
D) Part I of Schilling test = 2.5%; part II of Schilling test = 2.5%.

Question 17

Neurological symptoms are prevalent in Vitamin B₁₂ deficiency because of:

Accepted Answer

A) Antibodies to intrinsic factor. 
B) Decreased secretion of intrinsic factor. 
C) Improper fatty acid metabolism. 
D) Improper metabolism of methionine. 
A) Antibodies to intrinsic factor. 
B) Decreased secretion of intrinsic factor. 
C) Improper fatty acid metabolism. 
D) Improper metabolism of methionine.

Question 18

Which of the following tests would help differentiate TEC from DBA?

Accepted Answer

A) RBC count and RBC indices 
B) Bone marrow cellularity and M:E ratio 
C) Fetal erythrocyte characteristics 
D) Ham test 
A) RBC count and RBC indices 
B) Bone marrow cellularity and M:E ratio 
C) Fetal erythrocyte characteristics 
D) Ham test

Question 19

Aplastic anemia usually is first noted by bleeding and the presence of petechial hemorrhages.What clinical sign in the early stages of the disease should bring doubt to the diagnosis of aplastic anemia?

Accepted Answer

A) Hepatosplenomegaly 
B) Splenomegaly 
C) Lymph node enlargement 
D) Fever 
A) Hepatosplenomegaly 
B) Splenomegaly 
C) Lymph node enlargement 
D) Fever

Question 20

What is a viable explanation as to why some individuals suffer stem cell damage when exposed to chemical agents and others do not?

Accepted Answer

A) Longer life span of some red cells 
B) Superior detoxification 
C) Autoimmune disorders 
D) Lack of exposure 
A) Longer life span of some red cells 
B) Superior detoxification 
C) Autoimmune disorders 
D) Lack of exposure

Exam 12: Megaloblastic and Nonmegaloblastic Macrocytic Anemias

Which of the following is found in megaloblastic macrocytosis and not in nonmegaloblastic macrocytosis?

Deficiencies in folic acid lead to which of the following?

Which of the following is found in megaloblastic anemia but not nonmegaloblastic macrocytic anemia?

Which of the following describe the bone marrow in a patient with Fanconi's syndrome?

Acquired chronic pure red cell aplasia is a rare disorder encountered in association with several autoimmune disorders.What does the mechanism appear to be?

How can infection with the Epstein-Barr virus (EBV) lead to aplastic anemia?

Pernicious anemia is a disorder characterized by:

A patient taking chloramphenicol is at risk for developing aplastic anemia because of which of the following?

Macrocytes are often seen in hospitalized alcoholics due to:

Which CDA is characterized by a positive Ham test and a negative sucrose lysis test?

Megaloblastic anemia is most often caused by deficiencies of what two components?

The cytopenias associated with MDS are due to:

Neurological symptoms are prevalent in Vitamin B₁₂ deficiency because of:

Which of the following tests would help differentiate TEC from DBA?

Aplastic anemia usually is first noted by bleeding and the presence of petechial hemorrhages.What clinical sign in the early stages of the disease should bring doubt to the diagnosis of aplastic anemia?

What is a viable explanation as to why some individuals suffer stem cell damage when exposed to chemical agents and others do not?

Introduction

Cellular Homeostasis

Hematopoiesis

Structure and Function of Hematopoietic Organs

The Erythrocyte

Hemoglobin

The Leukocyte

Introduction to Anemia

Anemias of Disordered Iron Metabolism and Heme Synthesis

Hemoglobinopaties: Qualitative Defects

Thalassemia

Introduction to Hemolytic Anemia

Hemolytic Anemia: Membrane Defects

Hemolytic Anemia: Enzyme Deficiencies

Hemolytic Anemia: Immune Anemias

Hemolytic Anemia: Nonimmune Defects

Nonmalignant Granulocyte and Monocyte Disorders

Nonmalignant Lymphocyte Disorders

Introduction to Hematopoietic Neoplasms

Myeloproliferative Disorders

Myelodysplastic Syndromes

Acute Myeloid Leukemias

Acute Lymphoblastic Leukemias

Lymphoid Malignancies: Chronic Lymphoid Leukemias, Lymphomas, and Plasma Cell Neoplasms

Hematopoietic Stem Cell Transplantation

Morphologic Analysis of Body Fluids in the Hematology Laboratory

Primary Hemostasis

Secondary Hemostasis and Fibrinolysis

Disorders of Primary Hemostasis

Disorders of Secondary Hemostasis

Thrombophilia

Hematology Procedures and Hemostasis

Bone Marrow Examination

Automation in Hematology and Hemostasis

Flow Cytometry

Chromosome Analysis of Hematopoietic and Lymphoid Disorders

Molecular Analysis of Hematologic Diseases

Laboratory Testing in Coagulation

Quality Assessment in the Hematology Laboratory

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