Megaloblastic anemia with hypersegmented neutrophil

People seem to love the quizzes! Here’s another one, in a more traditional format, this time on anemia.

Q1. Which of the following red cell indices tells you how big your patient’s red cells are?

  1. RBC
  2. Hgb
  3. MCV
  4. RDW
  5. MCHC

Q2. The RDW measures:

  1. The average concentration of hemoglobin in each red cell
  2. The total number of red cells
  3. The percentage of blood volume that is composed of red cells
  4. The variation in red cell size (all the same size vs. some big ones and some little ones)
  5. The height of the average Christian Louboutin heel

Q3. “Chromasia” refers to:

  1. How big the red cells are
  2. How widely spaced the red cells are
  3. How much hemoglobin is in the red cells
  4. What color the red cells are
  5. The age of the red cell

Q4. A 40-year-old female says she feels tired all the time. On exam, you note that she is tachycardic and pale. You order a CBC, which shows the following: Hgb 10 g/dL (12-16), MCV 75 (80-100). Her reticulocyte count is not increased. Which of the following is most likely?

  1. She has iron-deficiency anemia
  2. She has megaloblastic anemia, probably due to folate deficiency
  3. She has megaloblastic anemia, probably due to B12 deficiency
  4. She has a hemolytic anemia

Q5. A 60-year-old male has a hemoglobin of 9 g/dL. He also has the following lab results: MCV normal; LDH increased; haptoglobin decreased. Which of the following is most likely?

  1. Iron-deficiency anemia
  2. Megaloblastic anemia
  3. Hemolytic anemia

Q6. You order a DAT, which comes back positive for complement, but not IgG. What is the most likely diagnosis?

  1. Hereditary spherocytosis
  2. Warm autoimmune hemolytic anemia
  3. Cold autoimmune hemolytic anemia
  4. Any of a number of non-immune causes of hemolysis

Q7. What causes the anemia in sickle cell disease?

  1. An inability of the red cell to reduce organic peroxides.
  2. An abnormal hemoglobin which polymerizes and irreversibly injures the red cell.
  3. Insufficient Hgb A and excess unpaired β, γ, and δ chains.
  4. Insufficient Hgb A and excess unpaired α chains.
  5. Consumption of red cells by splenic macrophages.

Q8. A 32-year-old female presents for a routine physical. Her CBC shows the following: Hgb 9 g/dL(12-16), MCV 72 (80-100), RBC 6.4 (4.5-6.0), RDW 12.8% (12-13.5) . What is the most likely diagnosis?

  1. Iron-deficiency anemia
  2. Thalassemia
  3. Megaloblastic anemia
  4. Autoimmune hemolytic anemia
  5. Microangiopathic hemolytic anemia

Q9. On a routine physical examination of an elderly male patient with no other medical problems, you note that his earlobes and fingertips are pale and slightly bluish. A CBC shows a hemoglobin of 10.6 g/dL (12 – 16) and an MCV of 88 (80 -100). Numerous red blood cell agglutinates are seen on the blood smear, made by smart technologists in your laboratory. Which of the following statements is true?

  1. The antibody bound to the patient’s red blood cells in this disorder is probably IgG
  2. Complement is probably bound to the patient’s red cells
  3. The spleen is the main site of red cell destruction in this patient
  4. 1 and 3
  5. 1, 2, and 3

Answers: Q1. 3, Q2. 4, Q3. 3, Q4. 1, Q5. 3, Q6. 3, Q7. 2, Q8. 2, Q9. 2