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WorksheetsHEMA 1 MODULE 7 AND 8 QUIZ
Total questions: 100
Worksheet time: 1hrs 17mins
The process of formation and development of blood cells is termed:
Hematopoiesis
Hematemesis
Hematocytometry
Hematorrhea
During the second trimester of fetal development, the primary site of blood cell production is the:
Bone marrow
Spleen
Lymph nodes
Liver
Which one of the following organs is responsible for the maturation of T lymphocytes and regulation of their expression of CD4 and CD8?
Spleen
Liver
Thymus
Bone marrow
The best source of active bone marrow from a 20-year-old would be:
Iliac crest
Femur
Distal radius
Tibia
Physiologic programmed cell death is termed:
Angiogenesis
Apoptosis
Aneurysm
Apohematics
Which organ is the site of sequestration of platelets?
Spleen
Liver
Thymus
Bone marrow
Which one of the following morphologic changes occurs during normal blood cell maturation:
Increase in cell diameter
Development of cytoplasm basophilia
Condensation of nuclear chromatin
Appearance of nucleoli
What growth factor is produced in the kidneys and is used to treat anemia associated with kidney disease?
EPO
TPO
G-CSF
KIT ligand
Which one of the following cytokines is required very early in the differentiation of a hematopoietic stem cell
IL-2
IL-8
EPO
FLT3 ligand
When a patient has severe anemia and the bone marrow is unable to effectively produce red blood cells to meet the increased demand, one of the body’s responses is:
Extramedullary hematopoiesis in the liver and spleen
Decreased production of erythropoietin by the kidney
Increased apoptosis of erythrocyte progenitor cells
Increase the proportion of yellow marrow in the long
bones
Hematopoietic stem cells produce all lineages of blood
cells in sufficient quantities over the lifetime of an individual because they
Are unipotent
Have the ability of self-renewal by asymmetric division
Are present in large numbers in the bone marrow niches
Have a low mitotic potential in response to growth factors
Which of the following is an erythrocyte progenitor?
Pronormocyte
Reticulocyte
Colony Forming Unit-Erythrocyte
Orthochromic normoblast
Which of the following is the most mature normoblast?
Orthochromic normoblast
Basophilic normoblast
Pronormoblast
Polychromatic normoblast
What erythroid precursor can be described as follows: the cell is of medium size compared with other normoblasts, with an N:C ratio of nearly 1:1. The nuclear chromatin is condensed and chunky throughout the nucleus. No nucleoli are seen. The cytoplasm is a muddy, blue-pink color.
Reticulocyte
Pronormoblast
Orthochromic normoblast
Polychromatic normoblast
Which of the following is not related to the effects of erythropoietin?
The number of divisions of a normoblast
The formation of pores in sinusoidal endothelial cells for marrow egress
The time between mitoses of normoblasts
The production of antiapoptotic molecules by erythroid progenitors
Hypoxia stimulates RBC production by:
Inducing more pluripotent stem cells into the erythroid lineage
Stimulating EPO production by the kidney
Increasing the number of RBC mitoses
Stimulating the production of fibronectin by macrophages of the bone marrow
In the bone marrow, RBC precursors are located:
In the center of the hematopoietic cords
Adjacent to megakaryocytes along the adventitial cell lining
Surrounding fat cells in apoptotic islands
Surrounding macrophages in erythroid islands
What single feature of normal RBCs is most responsible for limiting their life span?
Loss of mitochondria
Increased flexibility of the cell membrane
Reduction of hemoglobin iron
Loss of the nucleus
Intravascular or fragmentation hemolysis is the result of trauma to RBCs while in the circulation.
True
False
Extravascular hemolysis occurs when
RBCs are mechanically ruptured
RBCs extravasate from the blood vessels into the tissues
Splenic macrophages ingest senescent cells
Erythrocytes are trapped in blood clots outside the blood vessels
A pronormoblast in its usual location belongs to the RBC mass of the body, but not to the erythron.
True
False
. A cell has an N:C ratio of 4:1. Which of the following statements would describe it?
The bulk of the cell is composed of cytoplasm.
The bulk of the cell is composed of nucleus
The proportions of cytoplasm and nucleus are roughly
equal.
None of the choices
Which RBC process does not require energy?
Oxygen transport
Cytoskeletal protein deformability
Preventing the peroxidation of proteins and lipids
Maintaining cytoplasm cationic electrochemical gradients
What pathway anaerobically generates energy in the form of ATP?
Hexose monophosphate pathway
Rapoport-Luebering pathway
Embden-Meyerhof pathway
2,3-BPG pathway
Which is true concerning 2,3-DPG?
The least abundant of RBC organophosphates
Enhances O2 release from hemoglobin
Source of RBC glucose
Source of RBC ATP
To survive, the RBC must detoxify peroxides. What
hexose-monophosphate shunt product(s) accomplishes detoxification?
ATP
2,3-DPG
Pyruvic and lactic acid
NADPH and reduced glutathione
Which of the following helps maintain RBC shape?
Membrane phospholipids
Cytoskeletal proteins
GPI anchor
Glycocalyx
The glycolipids of the RBC membrane:
Provide flexibility
Carry RBC antigens
Constitute ion channels.
Attach the cytoskeleton to the lipid layer
RBC membranes block passage of most large molecules such as proteins, but allow passage of small molecules such as the cations Na+, K+, and Ca2+. What is the term for this membrane property?
Semipermeable
Deformable
Intangible
Flexible
RBC membrane phospholipids are arranged:
In a hexagonal lattice
In chains beneath a protein exoskeleton.
In two layers whose composition is asymmetric
So that hydrophobic portions are facing the plasma.
RBC membrane cholesterol is replenished from the:
Plasma
Mitochondria
Cytoplasm
EMB pathway
The hemoglobin iron ion may become oxidized to the +3 valence state by several pathological mechanisms. What portion of the Embden-Meyerhof pathway reduces iron to the physiologic +2 valence state?
Methemoglobin reductase pathway
Hexose monophosphate pathway
Rapoport-Luebering pathway
The 2,3-BPG shunt
Which of the following is an example of a transmembrane or integral membrane protein?
Glycophorin A
Ankyrin
Spectrin
Actin
Abnormalities in the horizontal and vertical linkages
of the transmembrane and cytoskeletal RBC membrane proteins may be seen as:
Shape changes
Methemoglobin increase
Reduced hemoglobin content
Enzyme pathway deficiencies
A hemoglobin molecule is composed of:
One heme molecule and four globin chains
Ferrous iron, protoporphyrin IX, and a globin chain
Protoporphyrin IX and four globin chains
Four heme molecules and four globin chains
Normal adult Hb A contains which polypeptide chains?
alpha and beta
alpha and delta
alpha and gamma
alpha and epsilon
The predominant hemoglobin found in a healthy newborn is:
Gower-1
Gower-2
Hb A
Hb F
What is the normal distribution of hemoglobins in healthy adults?
80% to 90% Hb A1, 5% to 10% Hb A2, 1% to 5% Hb F
80% to 90% Hb A2, 5% to 10% Hb A1, 1% to 5% Hb F
>95% Hb A1, <3.5% Hb A2, 1% to 2% Hb F
>90% Hb A1, 5% Hb F, <5% Hb A2
Which of the following is a description of the structure of oxidized hemoglobin?
Hemoglobin carrying oxygen on heme; synonymous with oxygenated hemoglobin
Hemoglobin with iron in the ferric state (methemoglobin) and not able to carry oxygen
Hemoglobin with iron in the ferric state so that carbon dioxide replaces oxygen in the heme structure
Hemoglobin carrying carbon monoxide; hence “oxidized”
refers to the single oxygen
Iron is transported in plasma via:
Hemosiderin
Ferritin
Transferrin
Hemoglobin
What is the major metabolically available storage form of iron in the body?
Hemosiderin
Ferritin
Transferrin
Hemoglobin
The total iron-binding capacity (TIBC) of the serum is an indirect measure of which iron-related protein?
Hemosiderin
Ferritin
Transferrin
Hemoglobin
What membrane-associated protein in enterocytes transports iron from the intestinal lumen into the enterocyte?
Transferrin
Ferroportin
DMT1
Ferrochelatase
Iron is transported out of macrophages, hepatocytes, and enterocytes by what membrane protein?
Transferrin
Ferroportin
DMT1
Ferrochelatase
The transfer of iron from the enterocyte into the plasma is REGULATED by
Transferrin
Ferroportin
Hephaestin
Hepcidin
The normal sequence of blood cell development is
yolk sac—red bone marrow—liver and spleen
yolk sac—thymus—liver and spleen—red bone marrow
yolk sac—liver and spleen—red bone marrow
liver and spleen—yolk sac—red bone marrow
The maturational sequence(s) of the erythrocyte is
(are)
rubriblast—prorubricyte—rubricyte—metarubricyte reticulocyte—mature erythrocyte
prorubricyte—rubricyte—metarubricyte—reticulocyte—mature erythrocyte
pronormoblast—basophilic normoblast-polychromatophilic normoblast—orthochromic normoblast—reticulocyte—mature erythrocyte
All of the above
As a blood cell matures, the overall cell diameter in most cases
increases
decreases
remains the same
None of the given choices
As a blood cell matures, the ratio of nucleus to cytoplasm (N:C) in most ca
increases
decreases
remains the same
None of the given choices
The chromatin pattern, in most cells, as the cell
matures
becomes more clumped
becomes less clumped
remains the same
Any of the choices
The presence of nucleoli is associated with
immature cells
all young cells, except myeloblasts
only erythroblasts
disintegrating cells
Which of the following is (are) characteristic(s) of erythropoietin?
Glycoprotein
Secreted by the liver
Secreted by the kidneys
All of the given choices
Which of the following is a characteristic of erythropoietin?
Produced primarily in the liver of the unborn
Gene for erythropoietin is found on chromosome 11
Most erythropoietin is secreted by the liver in adults
Cannot cross the placental barrier
Stimulation of erythropoietin is caused by
tissue hypoxia
hypervolemia
inflammation
infection
What is the immature erythrocyte found in the bone
marrow with the following characteristics: 12 to 17 mm in diameter, N:C of 4:1, nucleoli not usually apparent, and basophilic cytoplasm?
Rubriblast (pronormoblast)
Reticulocyte
Metarubricyte (orthochromatic normoblast)
Prorubricyte (basophilic normoblast)
The nucleated erythrocyte with a reddish pink cytoplasm and condensed chromatin pattern is a
rubricyte (polychromatic normoblast)
basophilic normoblast (prorubricyte)
metarubricyte (orthochromatic normoblast)
None of the choices
With a normal diet, an erythrocyte remains in the reticulocyte stage in the circulating blood for
1 day
3 days
35 days
120 days
In a Wright-stained peripheral blood film, the reticulocyte will have a blue appearance. This is referred to as
megaloblastic maturation
bluemia
polychromatophilia
erythroblastosis
In the reticulocyte stage of erythrocytic development
nuclear chromatin becomes more condensed
RNA is catabolized and ribosomes disintegrate
full hemoglobinization of the cell occurs
RNA is catabolized and ribosomes disintegrate and full hemoglobinization of the cell occurs
On a Wright-stained peripheral blood smear, stress or
shift reticulocytes are
smaller than normal reticulocytes
about the same size as normal reticulocytes
larger than normal reticulocytes
noticeable because of a decreased blue tint
Normal adult hemoglobin has
two alpha and two delta chains
three alpha and one beta chains
two alpha and two beta chains
two alpha and two beta chains
The number of heme groups in a hemoglobin molecule is
1
2
3
4
Increased amounts of 2,3-DPG _____ the oxygen affinity of the hemoglobin molecules
increases
decreases
does not alter
None of the choices
If normal adult (A1) and fetal hemoglobin F are compared, fetal hemoglobin has _____ affinity for oxygen
less
the same
a greater
None of the choices
Oxyhemoglobin is a _____ than deoxyhemoglobin.
weaker acid
stronger acid
Heme is synthesized predominantly in the
liver
red bone marrow
mature erythrocytes
both in the liver and red bone marrow
If globin synthesis is insufficient in a person, iron accumulates in the cell’s cytoplasm as
_____ aggregates.
transferrin
ferritin
albumin
iron
Increased erythropoietin production in secondary polycythemia can be caused by
chronic lung disease
smoking
renal neoplasms
all of the choices
Relative polycythemia exists when
increased erythropoietin is produced
the total blood volume is expanded
the plasma volume is increased
the plasma volume is decreased
Which of the following is (are) characteristic(s) of megaloblastic maturation?
Cells of some leukocytic cell lines are smaller than normal
Nuclear maturation lags behind cytoplasmic maturation
Cytoplasmic maturation lags behind nuclear maturation
Erythrocytes are smaller than normal
Which of the following hemoglobin types is the major type present in a normal adult?
A1
S
A2
Bart
Match the hemoglobin types.
Hgb A2
Two alpha and two delta chains
Zeta chains and either epsilon or gamma chains
Two alpha and two beta chains
Two alpha and two gamma chains
Fetal hemoglobin (hemoglobin F) persists until
a few days after birth
a few weeks after birth
several months after birth
adulthood
Cellulose acetate at pH 8.6 separates the hemoglobin
fractions
Hgb S
Hgb H
Hgb A
both Hgb S and Hgb A
If an alkaline (pH 8.6) electrophoresis is performed,
hemoglobin E has the same mobility as hemoglobin
S
F
A
C
The limited metabolic ability of erythrocytes is owing
to
the absence of RNA
the absence of ribosomes
no mitochondria for oxidative metabolism
the absence of DNA
The Embden-Meyerhof glycolytic pathway uses _____ % of the erythrocyte’s total glucose
10
20
50
90
The end product of the Embden-Meyerhof pathway of
glucose metabolism in the erythrocyte is
pyruvate
lactate
glucose-6-phosphate
the trioses
The net gain in ATPs in the Embden-Meyerhof glycolytic pathway is
1
2
4
6
The most common erythrocytic enzyme deficiency
involving the Embden-Meyerhof glycolytic pathway is
a deficiency of
ATPase
pyruvate kinase
glucose-6-phosphate dehydrogenase
lactic dehydrogenase
If a defect in the oxidative pathway (hexose monophosphate shunt) occurs, what will result?
Insufficient amounts of reduced glutathione
Denaturation of globin
Precipitation of Heinz bodies
All of the choices
The function of the methemoglobin reductase pathway is to
prevent oxidation of heme iron
produce methemoglobinemia
provide cellular energy
control the rate of glycolysis
The Luebering-Rapoport pathway
permits the accumulation of 2,3-DPG
promotes glycolysis
produces cellular energy
produces acidosis
As the erythrocyte ages
the membrane becomes less flexible with loss of cell membrane
cellular hemoglobin increases
enzyme activity, particularly glycolysis, decreases
all of the choices
Which of the following statements are true of the intravascular destruction of erythrocytes?
It accounts for less than 10% of normal erythrocyte breakdown
Hemoglobin is released directly into blood.
Alpha and beta dimers are bound to haptoglobin.
All of the choices
The upper limit of the reference range of hemoglobin in an adult male is
10.5 to 12.0 g/dL
12.5 to 14.0 g/dL
13.5 to 15.0 g/dL
14 to 18.0 g/dL
This hemoglobin found on a normal adult is the fastest to migrate at the anode during alkaline agar electrophoresis.
A2
F
A1
Gower
This hemoglobin variant is the fastest to migrate at the anode during alkaline agar electrophoresis.
S
F
A1
H
Shift to the left on the oxygen dissociation curve results in the following except?
Increase Hb affinity to O2
Increase delivery of oxygen to tissues
Decrease Carbon dioxide
Decrease 2,3 DPG
Shift to the right on the oxygen dissociation curve results on all of the following except?
Decrease oxygen affinity
Increase release of oxygen in the tissues
Decrease Carbon Dioxide
Increase 2, 3 DPG
Bart's Hemoglobin is due to the presence of?
4 beta chains
4 gamma chains
4 alpha chains
4 delta chains
Hemoglobin H variant is due to the presence of?
4 beta chains
4 gamma chains
4 alpha chains
4 delta chains
Hemoglobin C is due to?
The VALINE that replaces GLUTAMIC ACID at 6th position
The LYSINE that replaces GLUTAMIC ACID at 6th position
The LYSINE that replaces GLUTAMIC ACID at 26th position
Any of the choices
None of the choices
Hemoglobin E is due to?
The VALINE that replaces GLUTAMIC ACID at 6th position
The LYSINE that replaces GLUTAMIC ACID at 6th position
The LYSINE that replaces GLUTAMIC ACID at 26th position
Any of the choices
None of the choices
This variant of hemoglobin is irreversible and this can be caused by oxidation of hemoglobin caused by drugs and exposure to sulfur chemicals.
Methemoglobin
Sulfhemoglobin
Carboxyhemoglobin
Monoxyhemoglobin
This subfraction of hemoglobin A reflects the concentration of glycosylated hemoglobin accurately reflects the patient’s blood glucose level over the preceding weeks
A1a
A1b
A1c
A1d
It is a disease heme metabolism in which a primary abnormality in porphyrin biosynthesis leads to excessive accumulation and excretion of porphyrins or their precursors by the biliary and/or renal route.
Lead poisoning
Sideroblastic Anemia
Hereditary Hematochromatosis
Porphyria
Gene involved in the alpha and zeta chains.
Chromosome 16
Chromosome 11
Chromosome 6
Chromosome 10
This is the major pathway for RBC destruction.
Extravascular Pathway
Intravascular Pathway
The erythrocyte intracellular-to-extracellular ratios for Na and K are ______, respectively
1:12 and 25:1
12:1 and 1:25
1:25 and 1:12
25:1 and 12:1
