This document discusses red blood cells (RBCs), their production and function. Key points include: - RBCs are produced from pronormoblasts in the bone marrow through multiple cell divisions. A single pronormoblast can produce 16-32 mature RBCs. - Normal hemoglobin levels are 14-18 g/dL for men and 12-16 g/dL for women. Signs of anemia depend on severity and can include pale skin and fatigue. - Iron deficiency is the most common cause of anemia globally, resulting from blood loss, poor diet, or malabsorption. It progresses from iron depletion to iron-deficient erythropoiesis and finally iron deficiency

1. DR. JITHIN GEORGE

2.  Study of blood and blood products
 RBCS
 WBCS
 PLATELETS
 CLOTTING FACTORS

6.  Carry o2
 Erythropoiesis
 EPO stimulates the production
 4.5 to 5 .5 million
 Life span of 120 days
 Reticulocytes (rbcs precursors) make up 1-2 % of
rbcs

8.  In the bone marrow, the first morphologically
recognizable erythroid precursor is the
pronormoblast.
 This cell can undergo four to five cell
divisions, which result in the production of
16–32 mature red cells.

9.  According to WHO, anemia is defined as as a
hemoglobin level of ? Harrison’s 18th Ed. 449
 A. < 14 g/dL in men & < 13 g/dL in women
 B. < 13 g/dL in men & < 12 g/dL in women
 C. < 12 g/dL in men & < 11 g/dL in women
 D. < 11 g/dL in men & < 10 g/dL in women

10.  How many mature red cells are produced
from a pronormoblast ? Harrison’s 18th Ed.
448 A
 1 to 16
 B. 16 to 32
 C. 32 to 48
 D. 48 to 64

11.  Erythropoietin is produced and released by ?
Harrison’s 18th Ed. 448
 A. Glomerular capillaries
 B. Proximal tubular cells
 C. Peritubular capillary lining cells of kidney
 D. All of the above

12.  The mean hematocrit value for adult males
is ? Harrison’s 18th Ed. 448
 A. 42 %
 B. 45 %
 C. 47 %
 D. 49 %

13.  Normal hb = 16+/-2 14+/-2
 It can be acute or chronic
 Symptoms depend on above condition

14.  Signs of vascular instability appear with acute
losses of 10–15% of the total blood volume.
 When >30% of the blood volume is lost
suddenly- postural hypotension and tachycardia.
 If the volume of blood lost is >40% (i.e., >2 L in
the average-sized adult), signs of hypovolemic
shock including confusion, dyspnea, diaphoresis,
hypotension, and tachycardia appear

15.  The skin and mucous membranes may be
pale if the hemoglobin is <80–100 g/L (8–10
g/dL).
 If the palmar creases are lighter in color than
the surrounding skin when the hand is
hyperextended, the hemoglobin level is
usually <80 g/L (8 g/dL).

16.  If palmar creases are lighter in color than
surrounding skin, hemoglobin level is
usually ? Harrison’s 18th Ed. 449
 A. < 10 g/dL
 B. < 8 g/dL
 C. < 6 g/dL
 D. < 4 g/dL

17. 1. minor or vague
2. Generalized weakness
3. Easy fatigue ability
4. Poor concentration
5. Pallor
6. Skin changes ,nail changes
Cardiac findings-a forceful heartbeat, strong
peripheral pulses, and a systolic “flow” murmur

18.  Intravascular hemolysis with release of free
hemoglobin may be associated with acute
back pain, free hemoglobin in the plasma and
urine, and renal failure.

20.  Based on retic count
 Based on morphology/structure
 Based on type
 Based on nutrient defect

26. RDW correlates with ? Harrison’s 18th Ed. 450
 A. Anisocytosis
 B. Poikilocytosis
 C. Polychromasia
 D. All of the above

27.  Reticulocyte production index

29. 1. Hypo proliferative anemia
2. Ineffective erythropoiesis
3. Decreased red cell survival

30.  Early Iron deficiency (before hypochromic microcytic
red cells develop)
 Acute and chronic inflammation (including many
malignancies)
 Renal disease
 Hypo metabolic states such as protein malnutrition
and endocrine deficiencies
 Anemia's from marrow damage

31.  Most common anemia among
hypoproliferative anemias is ? Harrison’s 18th
Ed. 844
 A. Anemias associated with renal disease
 B. Anemias associated with chronic
inflammation
 C. Anemias associated with cancer
 D. Anemias associated with hypometabolic
states

32.  The key laboratory tests in distinguishing
between the various forms of
hypoproliferative anemia include the serum
iron and iron-binding capacity, evaluation of
renal and thyroid function, a marrow biopsy
or aspirate to detect marrow damage or
infiltrative disease, and serum ferritin to
assess iron stores.

33.  An iron stain of the marrow will determine the
pattern of iron distribution.
 Patients with the anemia of acute or chronic
inflammation show a distinctive pattern of
serum iron (low), TIBC (normal or low), percent
transferrin saturation (low), and serum ferritin
(normal or high).
 These changes in iron values are brought about
by hepcidin, the iron regulatory hormone that is
produced by the liver and is increased in
inflammation

34. The normal serum iron range is ? Harrison’s
18th Ed. 453
 A. 10 to 50 µg / Dl
 B. 50 to 150 µg / dL
 C. 150 to 250 µg / dL
 D. 250 to 450 µg / dL

35.  Hemolysis is most likely cause if reticulocyte
production index is more than ? Harrison’s
18th Ed. 454
 A. 2.5
 B. 3.5
 C. 4.5
 D. 5.5

36.  Most common
 50%
 Occurs in 3 stages
1. Negative iron balance
2. Iron deficient erythropoiesis
3. Ida

37. Causes
Increased Demand for Iron
Rapid growth in infancy or adolescence
Pregnancy
Erythropoietin therapy
Increased Iron Loss
Chronic blood loss
Menses
Acute blood loss
Blood donation
Phlebotomy as treatment for polycythemia vera
Decreased Iron Intake or Absorption
Inadequate diet
Malabsorption from disease (sprue, Crohn's disease)
Malabsorption from surgery (postgastrectomy)
Acute or chronic inflammation

38.  Signs related to iron deficiency depend on the severity and
chronicity of the anemia in addition to the usual signs of
anemia—fatigue, pallor, and reduced exercise capacity.
 Cheilosis (fissures at the corners of the mouth) and
koilonychia (spooning of the fingernails) are signs of
advanced tissue iron deficiency.
 The diagnosis of iron deficiency is typically based on
laboratory results.

39.  Iron studies-ferritin, total iron and tibc
 Evaluation of Bone Marrow Iron Stores
 Red Cell Protoporphyrin Levels
 Peripheral blood smear
 MCV

40.  Transfusion in acute setting
 Oral
1. Ferrous sulfate
2. Ferrous fumarate
3. Ferrous gluconate

42.  Typically, for iron replacement therapy, up to
200 mg of elemental iron per day is given,
usually as three or four iron tablets (each
containing 50–65 mg elemental iron) given
over the course of the day.
 Ideally, oral iron preparations should be
taken on an empty stomach, since food may
inhibit iron absorption.

43.  The response to iron therapy varies,
depending on the erythropoietin stimulus
and the rate of absorption.
 Typically, the reticulocyte count should
begin to increase within 4–7 days after
initiation of therapy and peak at 1–1. weeks.

44.  useful test in the clinic to determine the
patient’s ability to absorb iron is the iron
tolerance test.
 Two iron tablets are given to the patient on an
empty stomach, and the serum iron is
measured serially over the subsequent 2 h.
Normal absorption will result in an increase in
the serum iron of at least 100 μg/dL.

45.  Parenteral
 Body weight (kg) x 2.3 x (15–patient's hemoglobin,
g/dL) + 500 or 1000 mg (for stores).
1. Iron dextran
2. Sodium ferric gluconate
3. Iron sucrose injection
4. DD’S for microcytic and hypochromic?

46.  If a large dose of iron dextran is to be given
(>100 mg), the iron preparation should be
diluted in 5% dextrose in water or 0.9% NaCl
solution.
 The iron solution can then be infused over a
60- to 90-min period (for larger doses)

47. Which of the following is called “iron regulatory
hormone” ? Harrison’s 18th Ed. 845
 A. Ferritin
 B. Transferrin
 C. Erythropoietin
 D. Hepcidin

48. Amount of parenteral iron needed is calculated
by ? Harrison’s 18th Ed. 849
 A. Weight (kg) x 0.3 x (15 - patients Hb) + 500
or 1000 mg
 B. Weight (kg) x 1.3 x (15 - patients Hb) + 500
or 1000 mg
 C. Weight (kg) x 2.3 x (15 - patients Hb) + 500
or 1000 mg
 D. Weight (kg) x 3.3 x (15 - patients Hb) + 500
or 1000 mg

49.  Maturation disorders are divided into two
categories:
 nuclear maturation defects, associated with
macrocytosis, and
 cytoplasmic maturation defects, associated
with microcytosis and hypochromia usually
from defects in hemoglobin synthesis.

51.  Bilateral peripheral neuropathy or
degeneration (demyelination) of the
posterior and pyramidal tracts of the spinal
cord and, less frequently, optic atrophy or
cerebral symptoms.

53.  Peripheral Blood-macrocytes, neutrophils are
hyper segmented (more than five nuclear lobes)
 Bone Marrow examination
 MCV
 Treatment includes replacement of vit b12 and
folate

55. What value of MCV is diagnostic of
megaloblastic anemia ? Harrison’s 16th Ed.
605
 A. > 80 fL
 B. > 90 fL
 C. > 100 fL
 D. > 110 fL

56. Which of the following manifestations occur
with cobalamin deficiency but not with folic
acid deficiency ? Harrison’s 16th Ed. 605
 A. Gastrointestinal
 B. Neurologic
 C. Hematologic
 D. All of the above

57. Fish tapeworm - D. latum causes megaloblastic
anemia due to ? Harrison’s 18th Ed. 868
 A. Defective release of cobalamin from food
 B. Inadequate production of intrinsic factor
(IF)
 C. Competition for cobalamin
 D. Intestinal stasis