In which of the following anemias will a complete blood count (CBC) show a low hematocrit and hemoglobin?
Folate deficiency
Pernicious anemia
All choices are correct
Iron deficiency anemia
The Correct Answer is C
A. Folate deficiency results in megaloblastic anemia due to impaired DNA synthesis, which leads to a significant decrease in the production of mature erythrocytes. The complete blood count will demonstrate a reduction in both hemoglobin and hematocrit. These patients typically show macrocytic red blood cell indices on the laboratory report.
B. Pernicious anemia is a specific type of B-12 deficiency caused by a lack of intrinsic factor, preventing the effective production of red blood cells. As erythropoiesis fails, the total volume of red cells and the concentration of hemoglobin drop below the established reference range. This results in the classic clinical findings of anemia on a CBC.
C. All choices are correct because folate deficiency, pernicious anemia, and iron deficiency all share the common physiological endpoint of reduced red cell mass. While the underlying mechanisms differ—ranging from DNA synthesis failure to impaired heme production—the laboratory manifestation is consistently a low hemoglobin and hematocrit. These parameters are the standard metrics for identifying anemia.
D. Iron deficiency anemia occurs when depleted iron stores prevent the synthesis of the heme portion of the hemoglobin molecule. This leads to a quantitative decrease in the total amount of hemoglobin and a corresponding drop in the hematocrit percentage. It is the most common cause of microcytic anemia found on a standard CBC.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Regular physical exercise generally promotes cardiovascular health and efficient erythropoiesis rather than inducing hematologic disorders. While elite endurance athletes may experience pseudo-anemia due to expanded plasma volume, this does not involve the inflammatory cytokine pathways characteristic of ACD. Therefore, physical activity is not a risk factor for inflammatory anemia.
B. Iron-rich diet supplementation is a clinical intervention used to treat or prevent iron deficiency anemia by increasing available systemic iron. Anemia of chronic disease is not caused by a nutritional lack of iron, but by the sequestration of existing iron within the reticuloendothelial system. Diet cannot bypass the inflammatory blockade seen in chronic conditions.
C. Acute bacterial infections trigger a short-lived inflammatory response, but anemia of chronic disease typically requires a sustained inflammatory state lasting months. While acute infections cause transient physiological changes, they do not usually result in the long-term suppression of erythropoiesis seen in ACD. ACD is primarily associated with persistent, non-resolving pathological processes.
D. Chronic inflammatory disorders, such as rheumatoid arthritis or chronic infections, are the primary drivers of anemia of chronic disease. These conditions lead to the overproduction of interleukin 6, which stimulates hepcidin synthesis in the liver. Hepcidin inhibits iron export into the plasma, effectively starving the bone marrow of iron needed for hemoglobin synthesis.
Correct Answer is D
Explanation
A. Serum ferritin reflects the total iron stores within the body and is a critical marker for diagnosing iron deficiency or hereditary hemochromatosis. While patients with sickle cell disease may develop high ferritin levels due to chronic hemolysis or blood transfusions, it is not diagnostic. Ferritin cannot detect the qualitative defects in the hemoglobin molecule that define the sickle cell genotype and phenotype.
B. Hemoglobin A1C measures the percentage of hemoglobin that is chemically linked to sugar, providing an average blood glucose level over 3 months. This test is utilized exclusively for the diagnosis and management of diabetes mellitus and has no utility in identifying hemoglobinopathies. It does not provide information regarding the structure or percentage of fetal or sickle hemoglobin present in the patient's blood.
C. A complete blood count provides quantitative data on red blood cells, white blood cells, and platelets, identifying the presence of anemia. While a CBC may show decreased hemoglobin and hematocrit in a sickle cell patient, it cannot distinguish sickle cell from other forms of anemia. Without further specialized testing, a clinician cannot confirm the presence of hemoglobin S based on a standard hematology profile alone.
D. Hemoglobin electrophoresis is the definitive diagnostic procedure for identifying abnormal hemoglobin variants by separating them based on their unique electrical charges. This laboratory technique allows for the precise identification of hemoglobin S and can distinguish between sickle cell trait and sickle cell disease. It is the essential test for confirming the diagnosis of this genetic disorder by visualizing the migration patterns of different globins.
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