Clinical Case: Laboratory Tests for Anemia

A 32-year-old woman came to the primary clinic with complaints of persistent fatigue, pallor, and occasional dizziness for the past two months. She reported heavy menstrual bleeding and a diet low in red meat. The physical examination revealed a pulse rate of 100 beats per minute and other vital signs within normal limits. Inspection of the conjunctiva was pale. Laboratory blood tests showed a hemoglobin level of 8 g/dL, accompanied by a low mean corpuscular volume (MCV) and a low mean corpuscular hemoglobin concentration (MCHC). What further laboratory tests are most appropriate to suggest?

• Serum ferritin concentration

• Blood leucocyte index

• Bone marrow biopsy

• Total Iron Binding Capacity (TIBC)

• Iron serum concentration

A 55-year-old man came to the integrated service posyandu complaining of fatigue and paleness. The client had had diabetes for 10 years and was now diagnosed with chronic kidney failure. The client reported the results of ultrasound imaging and kidney biopsy, which showed massive damage to the structure of the kidney tissue. Blood laboratory examination revealed Hb: 8 g/dL, a decreased erythrocyte count, and MCV and MCHC results within normal limits. What is the most likely diagnosis?

• Normochromic normocytic anemia

• Chronic Anemia

• Normocytic hypochromic anemia

• Hypocytic normochromic anemia

• Macrocytic normochromic anemia

A 55-year-old man came to the integrated service posyandu complaining of fatigue and paleness. The client had had diabetes for 10 years and was now diagnosed with chronic kidney failure. The client reported the results of ultrasound imaging and kidney biopsy, which showed massive damage to the structure of the kidney tissue. Blood laboratory examination revealed Hb: 8 g/dL, a decreased erythrocyte count, and MCV and MCHC results within normal limits. What is the most appropriate event that happens in patients' erythropoiesis?

• Decrease the proliferation erythroblasts

• Decreases hemoglobin production

• Induces apoptosis of erythrocytes

• Decrease iron Binding

• Increase differentiation of erythrocyte

A 55-year-old man came to the integrated service posyandu complaining of fatigue and paleness. The client had had diabetes for 10 years and was now diagnosed with chronic kidney failure. The client reported the results of ultrasound imaging and kidney biopsy, which showed massive damage to the structure of the kidney tissue. Blood laboratory examination revealed Hb: 8 g/dL, a decreased erythrocyte count, and MCV and MCHC results within normal limits. Which substance is the most likely to be deficient in causing the problem?

• Erythropoietin

• Iron

• Folic acid

• Globin

• Heme

A patient living at high altitude mostly experiences hypoxia with elevated erythropoietin levels. Which condition is most likely to be found on his blood gas profile?

• Decrease oxygen saturation

• Increase carbon dioxide pressure

• Increase bicarbonate concentration

• Low blood pH

• Increase oxygen pressure

A 52-year-old woman presents with fatigue, pallor, and mild jaundice. Laboratory tests reveal macrocytic anemia with hypersegmented neutrophils on peripheral smear. Her serum vitamin B12 level is low. What condition is most likely to be found in her erythropoiesis?

• Loss of DNA synthesis for erythroblast

• Unstable erythrocyte membrane

• Low hemoglobin synthesis

• Increase erythropoietin production

• Increase iron utilization in the bone marrow

A 58-year-old woman presents with fatigue, glossitis, and paresthesia. Laboratory findings reveal macrocytic anemia, low serum vitamin B12, and positive anti-intrinsic factor antibodies. The diagnosis of pernicious anemia is made. What is the most appropriate structure to be damaged?

• Gastric parietal cell

• Ileum epithelial cell

• Hemoglobin

• Hepatocyte

• Erythroblast

A 6-year-old boy of Mediterranean descent presents with pallor, fatigue, and mild jaundice. His parents report a family history of anemia. Laboratory tests reveal microcytic hypochromic anemia, characterized by target cells on the peripheral smear. Hemoglobin electrophoresis shows decreased beta-globin chains. Which genetic mutation event is most likely responsible?

• Point mutation causing a premature stop codon in the HBB gene

• Large chromosomal deletion involving multiple genes

• A mutation in promoting number of protein of the alpha-globin gene

• Trinucleotide repeat promoting the beta-globin protein expression

• Mutation in mitochondrial DNA affecting hemoglobin synthesis

A 10-year-old girl presents with chronic fatigue and pallor. Her complete blood count shows anemia with microcytosis and hypochromia. Hemoglobin electrophoresis reveals an abnormal pattern suggestive of beta-thalassemia. Molecular studies indicate a mutation affecting the splicing of beta-globin pre-mRNA. What process related to mRNA is the most appropriate?

• Degradation of the beta-globin mRNA, reducing the amount of functional transcript available for translation

• Prevents the transcription of the beta-globin gene, leading to no mRNA production

• Enhancement of the stability of beta-globin mRNA, increasing globin chain synthesis

• Alteration of the amino acid sequence of alpha-globin chains, causing abnormal hemoglobin

• Increase in the rate of translation of beta-globin mRNA, leading to excess beta chains

A 7-year-old boy presents with severe pallor, jaundice, and splenomegaly. His laboratory results show marked anemia with reticulocytosis and elevated serum bilirubin. Peripheral blood smear reveals anisopoikilocytosis and nucleated red blood cells. Genetic testing confirms beta-thalassemia major with mutations causing absent beta-globin chain production. What is the most appropriate primary cellular consequence causing the case above?

• Accumulation of unpaired alpha-globin chains causing ineffective erythropoiesis and hemolysis

• Increased production of functional hemoglobin tetramers

• Enhanced stability of red blood cell membranes leading to prolonged lifespan

• Overproduction of beta-globin chains compensates for alpha-globin deficiency

• Increased synthesis of fetal hemoglobin (HbF) completely correcting anemia