NSG 533 EXAM 4 QUESTIONS AND
CORRECT ANSWERS VERIFIED
2025/2026.
HbA - ANS 2 alpha, 2 beta
Major adult hgb, about 97%, found normally in adults
HbA2 - ANS 2 alpha, 2 delta
Minor adult hgb, 2-3%
HbF - ANS 2 alpha, 2 gamma
Major fetal hgb, this type of hemoglobin is replaced by hemoglobin A shortly (6 months) after
birth
Greater affinity for oxygen, binds more readily
Helpful for growth/metabolism in infancy
HbS - ANS Quality dysfunction of beta (sickle trait/disease)
This type is commonly present in sickle cell disease
Normal value RBC - ANS 4.5-6
Normal value hemoglobin (Hgb) - ANS >13 in men
>12 in women
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,Normal value hematocrit (Hct) - ANS 40-50 in men
35-45 in women
Physical space that the Hb occupies as a percentage of the whole that red cells occupy
Usually 3x higher than Hb count
Normal value reticulocytes - ANS 0.5-2%
Low think underproduction, high think destruction/hemolysis or active bleeding
Normal value MCV (Mean corpuscular volume) - ANS 80-100 fl
Measure of the average volume of a RBC
Should not be used to rule in or rule out a specific cause of anemia
Underproduction Anemia: Microcytic - ANS MCV low (<80), microcytic; low retic count
Underproduction Anemia: Macrocytic - ANS MCV high (>100), macrocytic; low retic count
Example microcytic anemia - ANS Iron deficiency anemia
Examples of macrocytic anemia - ANS B12 deficiency anemia and folate deficiency anemia
Normocytic anemia - ANS Inflammation
Malignancy
RBC aplasia
Hospitalized patient (dilutional, iatrogenic phlebotomy)
Iron Deficiency: Microcytic anemia definition - ANS The body doesn't have enough iron,
which is needed to make hemoglobin
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Iron Deficiency: Microcytic anemia etiology - ANS Most common cause of anemia worldwide!
Blood loss from GI or menstrual most common
Inadequate intake of meats- rare
Malabsorption with patient's who have had gastrectomy, bariatric surgery procedures
(duodenum, and upper jejunum bypassed), celiac disease, or inflammatory bowel disease
Iron Deficiency: Microcytic anemia risk factors - ANS Heavy menstrual bleeding
Being female of child-bearing age
Gastric surgery
Iron Deficiency: Microcytic anemia clinical manifestations - ANS Fatigue
Irritability
Pagophagia-ice craving
Pica- craving for dirt, paint, or clay
Thinning, flattening, and then spooning of nail bed (koilonychia)
Hair loss
Glossitis and angular stomatitis
Gastritis
Restless leg syndrome
Iron Deficiency: Microcytic anemia diagnosis - ANS Early has normal CBC; Mild hgb 9-12
Low MCH, MCHC and increased RDW (new cells smaller and paler)
Low ferritin <100
High TIBC (total iron binding capacity)
Low serum Iron <30Zz
Poikilocytosis (abnormally shaped RBC's)
Transferrin <16%
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Bone Marrow biopsy - Absence of iron stores **Gold standard**
Iron Deficiency: Microcytic anemia complications - ANS Cardiac & respiratory (impaired
oxygen binding capacity)
B12 Deficiency: Macrocytic anemia definition - ANS Related to malabsorption of B12 when it
is not released from food proteins due to impaired gastric acid peptic digestion or lack of
parietal cells secreting intrinsic factor in the gastric fundus to bind in the ileum.
B12 is a substrate required for RBC production
B12 Deficiency: Macrocytic anemia etiology - ANS Can take years to develop given extensive
stores of vitamin B12 in the liver
Levels can be falsely low in folate deficiency, pregnancy, and use of oral contraception
Levels can be falsely normal in myeloproliferative disorders, liver disease and bacterial
overgrowth syndromes
Most common causes:
-Food cobalamin malabsorption
-Lack of intrinsic factor
-Dietary deficiency (rare unless strict vegetarian or malnourished): Animal food is primary
source: milk, cheese, eggs, meat
B12 Deficiency: Macrocytic anemia risk factors - ANS Impaired peptic acid digestion
Atrophic gastritis seen in chronic H. pylori infections, gastric surgery, and long-term acid-
suppressing medications (PPI's, metformin, colchicine, ethanol, neomycin)
Malabsorption in the terminal ileum 2/2 ileal resection/bypass or Crohn's disease
Lack of Intrinsic factor 2/2 gastrectomy or Pernicious anemia
B12 Deficiency: Macrocytic anemia clinical manifestations - ANS Paresthesias
Peripheral neuropathies
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
CORRECT ANSWERS VERIFIED
2025/2026.
HbA - ANS 2 alpha, 2 beta
Major adult hgb, about 97%, found normally in adults
HbA2 - ANS 2 alpha, 2 delta
Minor adult hgb, 2-3%
HbF - ANS 2 alpha, 2 gamma
Major fetal hgb, this type of hemoglobin is replaced by hemoglobin A shortly (6 months) after
birth
Greater affinity for oxygen, binds more readily
Helpful for growth/metabolism in infancy
HbS - ANS Quality dysfunction of beta (sickle trait/disease)
This type is commonly present in sickle cell disease
Normal value RBC - ANS 4.5-6
Normal value hemoglobin (Hgb) - ANS >13 in men
>12 in women
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Normal value hematocrit (Hct) - ANS 40-50 in men
35-45 in women
Physical space that the Hb occupies as a percentage of the whole that red cells occupy
Usually 3x higher than Hb count
Normal value reticulocytes - ANS 0.5-2%
Low think underproduction, high think destruction/hemolysis or active bleeding
Normal value MCV (Mean corpuscular volume) - ANS 80-100 fl
Measure of the average volume of a RBC
Should not be used to rule in or rule out a specific cause of anemia
Underproduction Anemia: Microcytic - ANS MCV low (<80), microcytic; low retic count
Underproduction Anemia: Macrocytic - ANS MCV high (>100), macrocytic; low retic count
Example microcytic anemia - ANS Iron deficiency anemia
Examples of macrocytic anemia - ANS B12 deficiency anemia and folate deficiency anemia
Normocytic anemia - ANS Inflammation
Malignancy
RBC aplasia
Hospitalized patient (dilutional, iatrogenic phlebotomy)
Iron Deficiency: Microcytic anemia definition - ANS The body doesn't have enough iron,
which is needed to make hemoglobin
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Iron Deficiency: Microcytic anemia etiology - ANS Most common cause of anemia worldwide!
Blood loss from GI or menstrual most common
Inadequate intake of meats- rare
Malabsorption with patient's who have had gastrectomy, bariatric surgery procedures
(duodenum, and upper jejunum bypassed), celiac disease, or inflammatory bowel disease
Iron Deficiency: Microcytic anemia risk factors - ANS Heavy menstrual bleeding
Being female of child-bearing age
Gastric surgery
Iron Deficiency: Microcytic anemia clinical manifestations - ANS Fatigue
Irritability
Pagophagia-ice craving
Pica- craving for dirt, paint, or clay
Thinning, flattening, and then spooning of nail bed (koilonychia)
Hair loss
Glossitis and angular stomatitis
Gastritis
Restless leg syndrome
Iron Deficiency: Microcytic anemia diagnosis - ANS Early has normal CBC; Mild hgb 9-12
Low MCH, MCHC and increased RDW (new cells smaller and paler)
Low ferritin <100
High TIBC (total iron binding capacity)
Low serum Iron <30Zz
Poikilocytosis (abnormally shaped RBC's)
Transferrin <16%
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Bone Marrow biopsy - Absence of iron stores **Gold standard**
Iron Deficiency: Microcytic anemia complications - ANS Cardiac & respiratory (impaired
oxygen binding capacity)
B12 Deficiency: Macrocytic anemia definition - ANS Related to malabsorption of B12 when it
is not released from food proteins due to impaired gastric acid peptic digestion or lack of
parietal cells secreting intrinsic factor in the gastric fundus to bind in the ileum.
B12 is a substrate required for RBC production
B12 Deficiency: Macrocytic anemia etiology - ANS Can take years to develop given extensive
stores of vitamin B12 in the liver
Levels can be falsely low in folate deficiency, pregnancy, and use of oral contraception
Levels can be falsely normal in myeloproliferative disorders, liver disease and bacterial
overgrowth syndromes
Most common causes:
-Food cobalamin malabsorption
-Lack of intrinsic factor
-Dietary deficiency (rare unless strict vegetarian or malnourished): Animal food is primary
source: milk, cheese, eggs, meat
B12 Deficiency: Macrocytic anemia risk factors - ANS Impaired peptic acid digestion
Atrophic gastritis seen in chronic H. pylori infections, gastric surgery, and long-term acid-
suppressing medications (PPI's, metformin, colchicine, ethanol, neomycin)
Malabsorption in the terminal ileum 2/2 ileal resection/bypass or Crohn's disease
Lack of Intrinsic factor 2/2 gastrectomy or Pernicious anemia
B12 Deficiency: Macrocytic anemia clinical manifestations - ANS Paresthesias
Peripheral neuropathies
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
