Question 131
A 33-year-old female presents to her obstetrician and gynecologist for a yearly physical examination. She reports that over the past 6 months, her menstrual periods have been much heavier than normal. And, over the past 2 months, she has become fatigued more easily, and sometimes short of breath with relatively minimal physical exertion. Laboratory testing reveals a hemoglobin of 8.8 g/dL. In the following chart, which choice best indicates the physiologic changes her body will undergo?
Answer for Question 131
Answer: A (Increase in cardiac output, plasma volume, and red cell 2,3 diphosphoglycerate)
Explanation: The patient is anemic, most likely an iron deficiency anemia as a result of her heavy menstrual periods. In response to anemia, the body will increase cardiac output to increase oxygen delivery to the tissues; the body will increase plasma volume to allow for better mobility of blood (i.e., decrease viscosity); and the body will increase the concentration of red blood cell 2,3-diphosphoglycerate, which in turn decreases hemoglobin affinity for oxygen, which will allow for oxygen to be more easily delivered to the tissues.
Question 132
A 34-year-old female presents to her obstetrician/gynecologist. She reports that over the past 12 months, her menstrual periods have been heavier than normal. And, over the past 4 months, she has become fatigued more easily, and sometimes short of breath with relatively minimal physical exertion. Laboratory testing reveals a hemoglobin of 8.1 g/dL. Additional laboratory testing reveals a ferritin of 3 ng/mL (normal range: 20-200 ng/mL), a total iron binding capacity of 700 µg/dL (normal range of 255-450 µg/dL), and a reticulocyte production index of <2. Of the following, which term best describes her anemia?
A. Supramicrocytic
B. Microcytic
C. Normocytic
D. Macrocytic
E. Supramacrocytic
Answer for Question 132
Answer: B (Microcytic)
Explanation: The patient has clinical features consistent with an iron deficiency anemia (i.e., occurring in a younger woman with heavy menstrual cycles). Iron deficiency anemia is characterized as a microcytic anemia. Early iron deficiency anemia can be normocytic; however, given the relatively low hemoglobin (a normal female hemoglobin is 12-16 g/dL; a mild iron deficiency anemia would have a hemoglobin that is >9.0 g/dL), and with the patient being symptomatic, it would be most likely that the patient would be microcytic.
Question 133
A 48-year-old Caucasian female who uses aspirin to treat her rheumatoid arthritis presents to an acute care clinic with complaints of abdominal pain. A guaiac test was negative. A complete blood cell count revealed a hemoglobin of 11.2 g/dL, hematocrit of 33%, MCV of 83 fL, and a red blood cell distribution width of 14. The reticulocyte production index was <2. Additional laboratory testing revealed a low serum iron and elevated ferritin concentration. Of the following, what is the most likely diagnosis?
A. Iron deficiency anemia
B. α-thalassemia
C. Anemia of chronic disease
D. Autoimmune hemolytic anemia
E. Hereditary spherocytosis
Answer For Question 133
Answer: C (Anemia of chronic disease)
Explanation: Given the clinical scenario (a normocytic anemia occurring in a patient with rheumatoid arthritis) with an elevated ferritin concentration and evidence of decreased synthesis of red blood cells, the best choice is anemia of chronic disease. In iron deficiency anemia, the ferritin would be decreased. α-thalassemia most commonly occurs in African-Americans and would be much less likely in a Caucasian. In both autoimmune hemolytic anemia and hereditary spherocytosis, the reticulocyte production index should be >2, as the body is responding to the hemolysis by increasing production of red blood cells to replace those that are destroyed.