Guyton & Hall: Textbook of Medical Physiology, 11th Edition

UNIT VI: Blood Cells, Immunity, and Blood Clotting

MULTIPLE CHOICE

1. Which one of the following measurements most accurately reflects the status of a
patient's tissue storage of iron?
a. Serum iron
b. Hemoglobin concentration
c. Serum ferritin
d. Hematocrit

ANS: C
Serum ferritin is in equilibrium with intracellular ferritin, the primary iron storage form.
If tissue storage iron (ferritin) is low, the level of serum iron will also be low, and vice
versa. Decreased serum ferritin levels are an early indication of iron deficiency.

2. Which one of the following most likely is associated with a decrease in circulating
erythropoietin concentration?
a. Moving from sea level to a high altitude
b. Decreased renal mass
c. Chronic intestinal blood loss
d. Severe pulmonary disease

ANS: B
Moving to a high altitude, developing severe pulmonary disease, and chronic blood loss
are all associated with increased erythropoietin concentration. Because erythropoietin is
produced primarily by the kidneys, decreased renal mass due to surgery, trauma, or
chronic renal disease would decrease the circulating erythropoietin concentration.

3. Which one of the following most likely is associated with a decrease in the
concentration of reticulocytes (newly released red blood cells) in the peripheral
blood?
a. Chronic blood loss
b. Bone marrow aplasia
c. Hemolytic anemia
d. Moving from sea level to a high altitude

ANS: B
Chronic blood loss, moving to a high altitude, and intravascular hemolysis all increase
the rate at which red blood cells are produced, thereby increasing the circulating
concentration of reticulocytes, which are immature red cells recently released from the
bone marrow. Bone marrow aplasia decreases blood cell production, thereby decreasing
the concentration of circulating reticulocytes.

Copyright 2006 by Elsevier, Inc.

Additional Test Bank 2

4. A 64-year-old, male patient develops a macrocytic anemia after surgery to remove a

large part of his stomach. Which one of the following is the most likely cause of this
patient's problem?
a. Poor absorption of dietary iron
b. Hereditary spherocytosis
c. Hemolytic anemia
d. Inadequate vitamin B12 absorption

ANS: D
Intrinsic factor is produced by parietal cells in the gastric glands of the stomach, binds
with vitamin B12 in food, protects B12 from acid digestion in the stomach, and facilitates
B12 absorption in the ileum. Gastric surgery does not affect iron absorption, which occurs
primarily in the small intestine; hereditary spherocytosis is a genetic disorder not caused
by surgery; and hemolytic anemia is an unlikely consequence of removal of part of the
stomach.

5. Which one of the following best represents the primary form in which iron is
transported in the plasma?
a. Intrinsic factor
b. Ferritin
c. Transferrin
d. Hemosiderin

ANS: C
The iron-binding and transport protein found in the plasma is transferrin, which carries
iron from the gut or spleen to developing red blood cells in the marrow. Intrinsic factor is
involved with vitamin B12 absorption; ferritin is the intracellular storage form for iron;
and hemosiderin is an extremely insoluble form that is often found inside cells when
excess iron is present in the body.

6. The principal site of erythropoietin production and release in a healthy human adult is
thought to be which one of the following?
a. Bone marrow
b. Red pulp of the spleen
c. Tubular or peritubular cells in the kidney
d. Liver sinusoids

ANS: C
About 90% of erythropoietin is synthesized in and released by the kidneys. The most
likely site of erythropoietin production within the kidney is within tubular or peritubular
cells in the renal cortex. Erythropoietin acts on cells in the bone marrow; the red pulp of
the spleen is involved with red blood cells destruction, not production; and the liver is
thought to produce only a small fraction of the circulating erythropoietin in a healthy
human subject.

Copyright 2006 by Elsevier, Inc.

Additional Test Bank 3

7. Which one of the following most likely is present in a patient with polycythemia vera
and a hematocrit greater than 55%?
a. Increased blood viscosity
b. Decreased blood volume
c. Increased erythropoietin concentration
d. Decreased arterial blood pressure

ANS: A
Blood viscosity largely depends on the concentration of erythrocytes in the blood, the
hematocrit. The increased hematocrit observed in patients with polycythemia vera results
in elevated blood viscosity and tends to increase arterial blood pressure and blood
volume. Because polycythemia vera represents elevated and uncontrolled production of
red blood cells and excess oxygen-carrying capacity, circulating erythropoietin levels
would most likely be low as the result of the negative feedback control of erythropoietin
concentration.

8. A very high rate of red blood cell destruction within the body would most likely lead
to elevated blood levels of which of the following?
a. Bilirubin
b. - and -Globin chains
c. Vitamin B12
d. Hemosiderin

ANS: A
When red blood cells are degraded within the spleen, the porphyrin portion of the
hemoglobin molecule is converted into the bile pigment bilirubin, which appears in the
blood and is carried to the liver for incorporation into bile. The - and -globin chains are
broken into their constituent amino acids and recycled; hemosiderin is a long-term
intracellular storage form of iron; and vitamin B12 levels depend on dietary availability
and absorption of vitamin B12 from the small intestine.

9. The increase in the concentration of circulating red blood cells caused by exposure to
high altitudes or by pulmonary disease is best described as which one of the
following?
a. Polycythemia vera
b. Erythroblastosis
c. Secondary polycythemia
d. Macrocytosis

ANS: C

Copyright 2006 by Elsevier, Inc.

 Additional Test Bank 4

Increased erythropoietin release triggered by hypoxemia associated with exposure to high

altitude or pulmonary disease results in increased red blood cell formation, an elevated
hematocrit, and a polycythemia that is appropriate and results from the hypoxic stimulus.
Erythroblastosis is a disorder associated with severe, immune-mediated red blood cell
destruction; macrocytosis refers to the size of red blood cells, not their concentration; and
polycythemia vera, or primary polycythemia, is a disorder in which red blood cell
production is increased and uncontrolled by erythropoietin.

10. Which of the following is considered the primary site of red blood cell production in
the fetus during the middle trimester of gestation?
a. Yolk sac
b. Liver and spleen
c. Placenta
d. Bone marrow

ANS: B
Early red blood cell production in the first few weeks of pregnancy occurs in blood
islands within the yolk sac. Late in pregnancy, in the last month before birth, red blood
cell production shifts to the bone marrow. During the middle trimester of pregnancy, red
blood cell production takes place primarily in the liver, as well as the spleen and lymph
nodes.

Copyright 2006 by Elsevier, Inc.