©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Nurs 5461/62 Uncommon Anemias Exam
Questions With Verified Answers
Anemia is - Answers✔a decrease in RBCs or Hbg- always reflects underlying disease •
Diagnosis depends on Hct [amount of RBCs in whole blood] or Hbg - Men- Hct <42% or Hbg
<14g - Women- Hct <37% or Hbg <12g
Approach to Evaluation of Anemia - Answers✔Data to be obtained on all anemic patients - Hct
and Hbg - MCV; MCHC - Reticulocyte Count - Smear of peripheral blood
Three questions should be asked - What is MCV? - What is basic mechanism of the anemia? -
Does patient have another problem associated with anemia?
Mean Corpuscular Volume [MCV] - Answers✔• Microcytic - MCV <80 • Normocytic - MCV
80-100 • Macrocytic - MCV >100
Basic Mechanism of Anemia - Answers✔Decreased production of RBC by marrow • Bleeding •
Hemolysis • Reticulocyte count used to assess response of marrow to anemia- normal
reticulocyte count is 1% • 1% of new cells that are being released daily into circulation from the
marrow
Reticulocyte Index- - Answers✔reticulocyte count x patient's Hct/45
Basic Mechanism of Anemia - Answers✔If patient is anemic, marrow should be able to acutely
triple its output of new cells • Reticulocyte count must be adjusted for level of anemia to obtain
reticulocyte index
In patients with bleeding or hemolysis, RI should be > or = 3% • Patients anemic from abnormal
production of RBCs have RI <3%, often <1.5%
Other Problems Commonly Associated with Anemia - Answers✔G6PD Deficiency •
Hemoglobinopathies • Thalassemia • Immune hemolysis after a virus • Chronic inflammation •
Malignancies • Hypothyroidism • Hyperthyroidism • Renal Failure • Aortic Valve Replacement •
Rheumatoid Arthritis • Collagen Vascular Disease
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Drugs Associated with Anemia - Answers✔Methyldopa • Quinine-pancytopenia • Quinidine •
Chloramphenicol • Gold Salts • Anti-TB drugs • Dilantin • Sulfa drugs-chronic dose •
Methotrexate • Amphotericin • Cis-platinum • Zidovudine
Anemia with a Low MCV - Answers✔For the most part, anemia with low MCV is iron
deficiency or thalassemia, Occasionally, anemia of chronic
disease can be microcytic if **longstanding ONLY
Iron Deficiency Anemia - Answers✔iN a child, man or postmenopausal woman aaa should be
considered GI bleeding until proved otherwise
IDA - Answers✔- History of eating ice, starch or clay • Pica - on PE sore tongue, brittle ridged
nails, spoon nails or cheilosis •
Serum Ferritin - Low - This **always reflects iron deficiency • Reticulocyte Index -
Inappropriately low for degree of anemia
Check stools for OB • TIBC- elevated • Serum Iron- low
IDA Treatment - Answers✔Treat patient based on cause • If iron therapy is given, reticulocyte
count hh after 7-10 days and Hct begins to hh after 7-10 days
Thalassemia - Answers✔In the adult, 3 Hbgs present in the mature RBC - Hbg A1 97% - Hbg
A2 02% - Hbg F 01%
Thalassemia 2 - Answers✔All 3 Hbgs have 2 alpha globin chains, but differ in the 2nd set of
globin chains
• Hbg A1 - 2 alpha chains - 2 beta chains • Hbg A2 - 2 alpha chains - 2 delta chains • Hbg F - 2
alpha chains - 2 gamma chains
Hemoglobin F - Answers✔During 1st year of life, Hbg. F is replaced by manufacturing of adult
Hbg [A1 and A2] • If Hbg. F persists and is >5% of Hbg. after 6 months- thalassemia
Hemoglobin F - Answers✔Thalassemia Minor - Hbg. F 5-10% • Thalassemia Major - Hbg. F 40-
90%
Thalassemia 3 - Answers✔Thalassemia is an inherited defect in globin chain production • Beta
thalassemia is seen in African Americans and those from Southeast Asia or MediterraneanAlpha
thalassemia is especially common in African Americans • Most patients are asymptomatic and
have microcytosis <70%, not Iron deficient
Diagnosis - Answers✔The combination of an extremely low MCV [<70%] and a mild anemia
are clues
ALL RIGHTS RESERVED.
Nurs 5461/62 Uncommon Anemias Exam
Questions With Verified Answers
Anemia is - Answers✔a decrease in RBCs or Hbg- always reflects underlying disease •
Diagnosis depends on Hct [amount of RBCs in whole blood] or Hbg - Men- Hct <42% or Hbg
<14g - Women- Hct <37% or Hbg <12g
Approach to Evaluation of Anemia - Answers✔Data to be obtained on all anemic patients - Hct
and Hbg - MCV; MCHC - Reticulocyte Count - Smear of peripheral blood
Three questions should be asked - What is MCV? - What is basic mechanism of the anemia? -
Does patient have another problem associated with anemia?
Mean Corpuscular Volume [MCV] - Answers✔• Microcytic - MCV <80 • Normocytic - MCV
80-100 • Macrocytic - MCV >100
Basic Mechanism of Anemia - Answers✔Decreased production of RBC by marrow • Bleeding •
Hemolysis • Reticulocyte count used to assess response of marrow to anemia- normal
reticulocyte count is 1% • 1% of new cells that are being released daily into circulation from the
marrow
Reticulocyte Index- - Answers✔reticulocyte count x patient's Hct/45
Basic Mechanism of Anemia - Answers✔If patient is anemic, marrow should be able to acutely
triple its output of new cells • Reticulocyte count must be adjusted for level of anemia to obtain
reticulocyte index
In patients with bleeding or hemolysis, RI should be > or = 3% • Patients anemic from abnormal
production of RBCs have RI <3%, often <1.5%
Other Problems Commonly Associated with Anemia - Answers✔G6PD Deficiency •
Hemoglobinopathies • Thalassemia • Immune hemolysis after a virus • Chronic inflammation •
Malignancies • Hypothyroidism • Hyperthyroidism • Renal Failure • Aortic Valve Replacement •
Rheumatoid Arthritis • Collagen Vascular Disease
, ©THEBRIGHT EXAM SOLUTIONS 2024/2025
ALL RIGHTS RESERVED.
Drugs Associated with Anemia - Answers✔Methyldopa • Quinine-pancytopenia • Quinidine •
Chloramphenicol • Gold Salts • Anti-TB drugs • Dilantin • Sulfa drugs-chronic dose •
Methotrexate • Amphotericin • Cis-platinum • Zidovudine
Anemia with a Low MCV - Answers✔For the most part, anemia with low MCV is iron
deficiency or thalassemia, Occasionally, anemia of chronic
disease can be microcytic if **longstanding ONLY
Iron Deficiency Anemia - Answers✔iN a child, man or postmenopausal woman aaa should be
considered GI bleeding until proved otherwise
IDA - Answers✔- History of eating ice, starch or clay • Pica - on PE sore tongue, brittle ridged
nails, spoon nails or cheilosis •
Serum Ferritin - Low - This **always reflects iron deficiency • Reticulocyte Index -
Inappropriately low for degree of anemia
Check stools for OB • TIBC- elevated • Serum Iron- low
IDA Treatment - Answers✔Treat patient based on cause • If iron therapy is given, reticulocyte
count hh after 7-10 days and Hct begins to hh after 7-10 days
Thalassemia - Answers✔In the adult, 3 Hbgs present in the mature RBC - Hbg A1 97% - Hbg
A2 02% - Hbg F 01%
Thalassemia 2 - Answers✔All 3 Hbgs have 2 alpha globin chains, but differ in the 2nd set of
globin chains
• Hbg A1 - 2 alpha chains - 2 beta chains • Hbg A2 - 2 alpha chains - 2 delta chains • Hbg F - 2
alpha chains - 2 gamma chains
Hemoglobin F - Answers✔During 1st year of life, Hbg. F is replaced by manufacturing of adult
Hbg [A1 and A2] • If Hbg. F persists and is >5% of Hbg. after 6 months- thalassemia
Hemoglobin F - Answers✔Thalassemia Minor - Hbg. F 5-10% • Thalassemia Major - Hbg. F 40-
90%
Thalassemia 3 - Answers✔Thalassemia is an inherited defect in globin chain production • Beta
thalassemia is seen in African Americans and those from Southeast Asia or MediterraneanAlpha
thalassemia is especially common in African Americans • Most patients are asymptomatic and
have microcytosis <70%, not Iron deficient
Diagnosis - Answers✔The combination of an extremely low MCV [<70%] and a mild anemia
are clues
