Ineffective and Insufficient Erythropoiesis

Question 1

It is the term used for marrow erythroid proliferative activity

Answer 1

Erythropoiesis

Question 2

Normal erythropoiesis occurs in bone marrow and is under the control of the hormone _____________ (produced by the kidney) and other growth factors and cytokinesis

Answer 2

erythropoietin

Question 3

refers to the production of erythroid precursor cells that are defective

Answer 3

Ineffective erythropoiesis

Question 4

defective precursors often undergo _________________ (programmed cell death) in the bone marrow before they have a chance to mature to the reticulocyte stage and be released into the peripheral circulation

Answer 4

apoptosis

Question 5

It is an impaired deoxyribonucleic acid [DNA] synthesis as a result of vitamin B12 or folate deficiency

Answer 5

megaloblastic anemia

Question 6

It is a deficient globin chain synthesis

Answer 6

thalassemia

Question 7

It is a deficient protoporphyrin synthesis

Answer 7

sideroblastic anemia

Question 8

Several conditions such as megaloblastic anemia, thalassemia, and sideroblastic anemia involve _____________________ as a mechanism of anemia

Answer 8

ineffective erythropoiesis

Question 9

When peripheral blood hemoglobin concentration
is low, it triggers an increase in ____________________ leading to increased erythropoietic activity

Answer 9

erythropoietin production

Question 10

refers to a decrease in the number of erythroid precursors in the bone marrow, resulting in decreased RBC production and anemia

Answer 10

Insufficient erythropoiesis

Question 11

Factors that can lead to a decreased RBC production

Answer 11

1. deficiency of Iron (inadequate intake, malabsorption, excessive loss from chronic bleeding)
2. deficiency of erythropoietin (renal disease)
3. loss of the erythroid precursors as a result of an autoimmune reaction (aplastic anemia, acquired pure red cell aplasia) or infection (parvovirus B19)

Question 12

Erythropoiesis can also be suppressed by ___________

Answer 12

infiltration of the bone marrow space with leukemia
cells or with nonhematopoietic cells (metastatic tumors, granulomas, or fibrosis)

Question 13

________________ with characteristic teardrop RBCs are formed with nonhematopoietic cells

Answer 13

myelophthisic anemia

Question 14

Anemia can also develop as a result of ____________ (such as a traumatic injury) or _____________ (such as an intermittently bleeding colonic polyp)

Answer 14

acute blood loss. chronic blood loss

Question 15

Increased hemolysis results in a shortened _____________, thus increasing the risk for anemia

Answer 15

RBC life span

Question 16

Chronic blood loss induces ____________ as a cause of anemia

Answer 16

iron deficiency

Question 17

With ________________, the bone marrow takes a few days to increase production of RBCs

Answer 17

acute blood loss and excessive hemolysis

Question 18

A complete blood count (CBC) is performed using an ________________ to determine the RBC count, hemoglobin concentration, hematocrit, RBC indices, white blood cell count, and platelet count to detect the presence of anemia.

Answer 18

automated blood cell analyzer

Question 19

The RBC indices include the ________________.

Answer 19

mean cell volume (MCV), mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC)

Question 20

The most important in the RBC indices is the _______________, a measure of the average RBC volume in femtoliters.

Answer 20

MCV

Question 21

It is an index of variation of cell volume in an RBC population

Answer 21

red cell distribution width (RDW)

Question 22

An RBC volume frequency distribution curve with the relative number of cells plotted on the ordinate and RBC volume (fL) on the abscissa

Answer 22

RBC histogram

Question 23

Reading RBC histogram:
In healthy individuals the distribution is ______________.

Answer 23

In healthy individuals the distribution is approximately Gaussian

Question 24

Reading RBC histogram:
Abnormalities include a shift in the curve to the _____________ (smaller cell population or microcytosis) or to the __________ (larger cell population or macrocytosis)

Answer 24

left, right

Question 25

It is the coefficient of variation of RBC volume expressed as a percentage

Answer 25

RDW

Question 26

It indicates the variation in RBC volume within the population measured

Answer 26

RDW

Question 27

An increased RDW correlates with

Answer 27

anisocytosis (variation in RBC diameter) on the peripheral blood film

Question 28

It serves as an important tool to assess the bone marrow’s ability to increase RBC production in response to an anemia

Answer 28

reticulocyte count

Question 29

young RBCs that lack a nucleus but still contain residual ribonucleic acid (RNA) to complete the production of hemoglobin

Answer 29

reticulocytes

Question 30

Reticulocyte count is determined by ________________

Answer 30

multiplying the percent reticulocytes by the RBC count

Question 31

A patient with a severe anemia may seem to be producing ___________ numbers of reticulocytes if only the percentage is considered

Answer 31

increased

Question 32

There are how many successive corrections that are made to the reticulocyte count to obtain a better representation of RBC production

Answer 32

2

Question 33

To obtain a corrected reticulocyte count, one corrects for the degree of anemia by ___________

Answer 33

multiplying the reticulocyte percentage by the patient’s hematocrit and dividing the result by 45 (the average normal hematocrit)

Question 34

It is a better indication of the rate of RBC production than is the corrected reticulocyte count.

Answer 34

reticulocyte production index (RPI)

Question 35

state-of-the-art automated blood cell analyzers determine the fraction of immature reticulocytes among the total circulating reticulocytes, called the _____________

Answer 35

immature reticulocyte fraction (IRF)

Question 36

It is helpful in assessing early bone marrow response after treatment for anemia

Answer 36

IRF

Question 37

Plays a crucial role in determining whether an anemia is due to an RBC production defect or to premature hemolysis and shortened survival defect

Answer 37

Analysis of the reticulocyte count

Question 38

If there is shortened RBC survival, as in the hemolytic anemias, the bone marrow tries to compensate by increasing RBC production to __________ into the peripheral circulation

Answer 38

release more reticulocytes

Question 39

Although an increased reticulocyte count is a hallmark of the hemolytic anemias, it can also be observed after __________________

Answer 39

acute blood loss

Question 40

Chronic blood loss does not lead to an appropriate increase in the reticulocyte count, but rather leads to _____________________________________

Answer 40

iron deficiency and a subsequent low reticulocyte count

Question 41

An inappropriately low reticulocyte count results from _____________________

Answer 41

decreased production of normal RBCs