NURS 640 EXAM 2025 QUESTIONS AND
ANSWERS
Normal Hgb level for men and women
Men less than 13
women less than 12
Normal Hct for men and women
Men 41%
Women 36%
Normal WBC count
5,000-10,000
Normal platelet count
150,000-400,000
Classification of anemia by Pathophysiology
Decreased red blood cell production (relative or absolute reticulocytopenia)
Hemoglobin synthesis lesion: iron deficiency, thalassemia, anemia of chronic disease,
hypoerythropoietinemia
DNA synthesis lesion: megaloblastic anemia, DNA synthesis inhibitor medications
Hematopoietic stem cell lesion: aplastic anemia, leukemia
,Bone marrow infiltration: carcinoma, lymphoma, fibrosis, sarcoidosis, Gaucher disease, others
Immune-mediated inhibition: aplastic anemia, pure red cell aplasia
Increased red blood cell destruction or accelerated red blood cell loss (reticulocytosis)
Acute blood loss
Hemolysis (intrinsic)
Membrane lesion: hereditary spherocytosis, elliptocytosis
Hemoglobin lesion: sickle cell, unstable hemoglobin
Glycolysis abnormality: pyruvate kinase deficiency
Oxidation lesion: glucose-6-phosphate dehydrogenase deficiency
Hemolysis (extrinsic)
Immune: warm antibody, cold antibody
,Microangiopathic: thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome,
mechanical cardiac valve, paravalvular leak
Infection: Clostridium perfringens, malaria
Hypersplenism
Special considerations of anemia in the older adults
anemia of older adults is present in up to 20% of individuals over age 85 years in whom a
thorough evaluation for an explanation of anemia is negative. It is a consequence of a relative
resistance to red blood cell production in response to erythropoietin, a decrease in erythropoietin
production relative to the nephron mass, and a negative erythropoietic influence of low levels of
chronic inflammatory cytokines in older adults; the serum iron is normal.
megaloblastic anemia
a blood disorder characterized by anemia in which the red blood cells are larger than normal,
Macrocytic Anemia
Vit B12 /folate def
aplastic anemia
Pancytopenia, Meds/ETOH that inhibit folate metabolism
-Elevated hemolysis
Non-megaloblastic anemia
Macrocytic Anemia
due to EtoH, Meds, Thyroid or Liver
, How to test Vitamin B12/ folate levels
Vitamin b12 (cobalamin), folate (folic acid)
Methylmalonate and homocysteine levels used to detect early deficiency.
anemia increase morbidity and mortality when associated with
Chronic kidney disease
malignancy
HF
Rheumatoid arthritis
HIV
Bowel inflammation
50% hospitalized adults
75% of elderly hospitalized adults
90% ICU patients by day 3
Anemia labs
1. CBC with differential or Hct with MCV
2. Reticu count
3. plt count
4. wright stained blood smear
5. serum ferritin, serum iron, and total iron binding capacity (TIBC)
Anemia of chronic disease
ANSWERS
Normal Hgb level for men and women
Men less than 13
women less than 12
Normal Hct for men and women
Men 41%
Women 36%
Normal WBC count
5,000-10,000
Normal platelet count
150,000-400,000
Classification of anemia by Pathophysiology
Decreased red blood cell production (relative or absolute reticulocytopenia)
Hemoglobin synthesis lesion: iron deficiency, thalassemia, anemia of chronic disease,
hypoerythropoietinemia
DNA synthesis lesion: megaloblastic anemia, DNA synthesis inhibitor medications
Hematopoietic stem cell lesion: aplastic anemia, leukemia
,Bone marrow infiltration: carcinoma, lymphoma, fibrosis, sarcoidosis, Gaucher disease, others
Immune-mediated inhibition: aplastic anemia, pure red cell aplasia
Increased red blood cell destruction or accelerated red blood cell loss (reticulocytosis)
Acute blood loss
Hemolysis (intrinsic)
Membrane lesion: hereditary spherocytosis, elliptocytosis
Hemoglobin lesion: sickle cell, unstable hemoglobin
Glycolysis abnormality: pyruvate kinase deficiency
Oxidation lesion: glucose-6-phosphate dehydrogenase deficiency
Hemolysis (extrinsic)
Immune: warm antibody, cold antibody
,Microangiopathic: thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome,
mechanical cardiac valve, paravalvular leak
Infection: Clostridium perfringens, malaria
Hypersplenism
Special considerations of anemia in the older adults
anemia of older adults is present in up to 20% of individuals over age 85 years in whom a
thorough evaluation for an explanation of anemia is negative. It is a consequence of a relative
resistance to red blood cell production in response to erythropoietin, a decrease in erythropoietin
production relative to the nephron mass, and a negative erythropoietic influence of low levels of
chronic inflammatory cytokines in older adults; the serum iron is normal.
megaloblastic anemia
a blood disorder characterized by anemia in which the red blood cells are larger than normal,
Macrocytic Anemia
Vit B12 /folate def
aplastic anemia
Pancytopenia, Meds/ETOH that inhibit folate metabolism
-Elevated hemolysis
Non-megaloblastic anemia
Macrocytic Anemia
due to EtoH, Meds, Thyroid or Liver
, How to test Vitamin B12/ folate levels
Vitamin b12 (cobalamin), folate (folic acid)
Methylmalonate and homocysteine levels used to detect early deficiency.
anemia increase morbidity and mortality when associated with
Chronic kidney disease
malignancy
HF
Rheumatoid arthritis
HIV
Bowel inflammation
50% hospitalized adults
75% of elderly hospitalized adults
90% ICU patients by day 3
Anemia labs
1. CBC with differential or Hct with MCV
2. Reticu count
3. plt count
4. wright stained blood smear
5. serum ferritin, serum iron, and total iron binding capacity (TIBC)
Anemia of chronic disease
