NR507/ NR 507 MIDTERM EXAM (LATEST 2024/ 2025 UPDATE) ADVANCED PATHOPHYSIOLOGY | COMPLETE, Exams of Nursing

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1. Hypersensitivity: Type 1
2. Hypersensitivity: Type 2
3. Difference Between Type 2 and Type 3
4. Difference Between Type 2 and Type 3 5. Hypersensitivity: Type 3-Examples 6. Scope of Damage of SLE-Type •Type 1: Allergic reaction •Mediated by IgE •Inflammation due to mast cell degranulation •Local symptoms: itching, rash •Systemic symptoms: wheezing •Most dangerous form is an anaphylactic reaction- systemic response-hypotension, severe bronchoconstriction •Main treatment: epinephrine reverses the effects •Type 2: Cytotoxic reaction; tissue specific (e.g. thyroid tissue) •Macrophages are the primary effectors cells involved •Can cause tissue damage or alter function •Grave's disease (hyperthyroidism)-example of altering thyroid function, but does not destroy thyroid tissue •Incompatible blood type-example of cell/tissue damage that occurs; severe transfusion reaction occurs and the transfused erythrocytes are destroyed by agglutination or complement-mediated lysis. •Type 3 is not organ specific the antibody binds to soluble antigen outside the cell surface that was released into the blood or body fluids, and the complex is then deposited in the tissues •Type 2 is organ specific •The antibody binds to the antigen on the cell surface •Rheumatoid arthritis- antigen/antibodies are deposited in the joints •Systemic Lupus Erythematosus (SLE)- very closely related to autoimmunity- antigen/antibodies deposit in organs that cause tissue damage •Facial rash confined to the cheeks (malar rash) •Discoid rash (raised patches, scaling) •Photosensitivity (development of skin rash developed 1 / 32 3 - autoimmune response 7. Scope of Damage of SLE-Type 3-autoimmune response cont. 8. Scope of Damage of SLE-Type 3-autoimmune response cont. 9. A Word About Autoimmunity 10. Alloimmunity

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11. Examples of Alloimmunity
12. Hypersensitivity: Type 4 as a result of exposure to sunlight) •Oral or nasopharyngeal ulcers •Hematologic disorders (hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia) •Immunologic disorders (antibodies against double-stranded DNA [dsDNA] or Smith [Sm] antigen, false-positive serologic test for syphilis, or antiphospholipid antibodies [anticardiolipin antibody or lupus anticoagulant]) •Non-erosive arthritis of at least two peripheral joints •Serositis (pleurisy, pericarditis) •Renal disorder (persistent proteinuria of >0.5 g/day or

3 g/day on dipstick or cellular casts) •Neurologic disorders (seizures or psychosis in the absence of known causes) •Presence of antinuclear antibody (ANA) •Autoimmune diseases can be familial. •Affected family members may not all develop the same disease, but several members may have different disorders characterized by a variety of hypersensitivity reactions •These include autoimmune and allergic reactions. •Associations with particular autoimmune diseases have been identified for a variety of major histocompatibility complex (MHC) alleles or non- MHC genes. •General term used to describe when an individual's immune system reacts against antigens on the tissues of other members of the same species

Hemolytic disease of the newborn, transplant rejection, transfusion reaction •Delayed response •Does not involve antigen/antibody complexes like Types I, II and III 2 / 32 •Is T-cell mediated Example- TB Test

13. Relationship be- • Organ rejection involves cytotoxicity (Type II) tween Type II and •Also, T-cells play a major role in organ rejection (Type Type IV Hypersen- IV-completely T-cell mediated) sitivity Reactions • Antigens from target cells stimulate T-cells to differentiate into cytotoxic (Type II) T-cells •These T-cells have direct cytotoxic activity along with help T-cells involved in delayed hypersensitivity (type IV).
14. Differentiating Be- •Type I: Immediate hypersensitivity reactions, termed tween the Rash of atopic dermatitis, are usually characterized by widely a Type 1 vs. Type IV distributed lesions, Reaction •Type IV: contact dermatitis (delayed hypersensitivity) consists of lesions only at the site of contact with the allergen •The key determinant is the timing of the rash:

• Type I: immediate
• Type IV: delayed-several days following contact-e.g. poison ivy

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Transferrin Saturation- NORMAL to SLIGHTLY IN- CREASE TEST Serum Ferritin Levels- NORMAL to INCREASE Red Blood Cell Distribution- INCREASE Serum Iron Levels- NORMAL to INCREASE Total Iron Binding Capacity- NORMAL Transferrin Saturation- Normal to Increase 4 / 32

23. Mean Corpuscular Hemoglobin Concentration (MCHC)
24. When is the Mean Corpuscular Hemoglobin Concentration (MCHC) NORMAL
25. When is the (MCHC) Mean Corpuscular Hemoglobin Concentration LOW
26. When is MEAN CORPUS- CULAR HEMOGLOBIN CONCEN- TRATION (MCHC)

HIGH

27. Iron Deficiency Anemia
28. Major Lab Marker for Anemia The measure of the average concentration or percentage of hemoglobin within a single RBC

• May be normal in many types of anemias (normochromic anemias) - Aplastic anemia
• Post-hemorrhagic anemia - Hemolytic anemia •May be low in:
• Iron deficiency anemia
• Sideroblastic anemia - Thalassemia •May be high in:
  • Hereditary spherocytosis- a result of mild cellular dehydration; MCV is low, because of membrane loss and c e l l d e h y d r a t i o n - L i ver disease
• Hyperthyroidism
• Sickle cell disease •Is a microcytic/hypochromic anemia
• Is caused by disorders of hemoglobin synthesis, particularly iron deficiency •Ferritin is an important measurement that reflects the body's total iron stores •The NP will order a ferritin level to get an idea of the body's total iron stores •Low ferritin reflects anemia, but does not tell you the type •Increased RBC distribution width (RDW) is one of the earliest lab markers in developing microcytic or macrocytic anemia •In future courses, you will learn how to use lab markers to diagnose the different types of anemia 5 / 32

29. Folate Deficiency
30. vitamin b 12 deficiency anemia

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31. Hemolytic Anemia
32. Acute Blood Loss Anemia
33. Aplastic Anemia •Diagnosing anemia is beyond the scope of this course. •Important to know what these terms mean and what type of anemias they signify. •Can cause a megaloblastic anemia •Is important to know who is at-risk •Alcoholics can easily get a folate deficiency •Fatigue •Dyspnea •Peripheral neuropathy in BLE (numbness and tingling)• Risk Factors:

• Older adults
• H-pylori infection
• Affects Vitamin B-12 absorption
• Who is at-risk? •Refer back to our hypersensitivity reactions •RBCs are destroyed Why?
• Mismatched blood types-destroys RBCs (Cytotoxic Type 2)
• Autoimmune hemolytic anemia due to autoantibodies against erythrocytes that the immune system perceives as an antigen and then attacks it - Allergic reaction to a drug causes drug- induced hemolytic anemia (drug-induced hemolytic anemia). •Trauma victims who are losing blood •Diagnosis is made by blood tests and bone marrow biopsy. •AA is suspected if levels of circulating erythrocytes, leukocytes, and platelets are diminished: - a granulocyte count less than 500/μL,
• a platelet count less than 20,000/μL, - absolute reticulocyte count less than or equal to 40 × 109/L. 6 / 32

37. BLOOD FLOW OF - Oxygen poor blood enter right atrium and flows into THE HEART right ventricle via vena cava

• Blood is pumped from right ventricle into pulmonary artery (goes into lungs)

34. Sickle Cell Anemia a genetic disorder in which erythroctyes take on an abnormal curved or "sickle" shape •Patients will be encountered who have sickle cell trait •The individual with sickle cell disease has inherited a normal Hb gene from one parent and an abnormal Hb gene for the other parent
35. thalassemia anemia

• Is an inherited blood disorder that causes decreased circulating hemoglobin •There are many possible genetic mutations

36. Valves of the heart tricuspid, pulmonary, mitral, aortic

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•When contractility is decreased, stroke volume falls, and left ventricular end-diastolic volume (LVEDV) increases. This causes dilation of the heart and an increase in preload. •The major risk factor in its development is long- standing hypertension •Review highlighted terms as needed

44. Left sided heart 1. Pnea, SOB failure 2. Crackles
    3. Oliguria
45. right sided heart 1. Jungular Vein Distention failure 2. Ascending Dependent Edema
    3. Weight Gain
       46. Differentiate between Right and Left Heart Failure
           • Sometimes right-sided heart failure can occur due to left-sided heart failure due to the back-up of fluid from the left side to the right •Sometime right-sided heart failure can occur without there being left-sided heart failure; This usually occurs because the person has long-standing pulmonary issues (COPD). Patients will have classic symptoms of 9 / 32 right-sided heart failure without symptoms of left- sided heart failure:
           • Right JVD distention, peripheral edema, hepatosplenomegaly
       47. Stages of HEART • Stage A: patient has risk factors (CAD) but no symp- FAILURE toms; no structural heart damage •Stage B: patient has structural heart damage (MI), but still has no symptoms •Stage C: patient is symptomatic with alteration in their daily functions due to dyspnea, swelling, etc. This is where there NYHA functional classifications come into play •Stage D: end-stage heart failure-have maximized medications to treat it-may need heart transplant or pacemaker
    4. Frothy Sputum
    5. Displaced Apical Pulse (Hypertrophy)
    6. Hepatomegaly (Liver Enlargement)

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48. NYHA Function- •Stage I: mild; no limitation of physical activity; Ordinary al Classifica- physical activity does not cause symptoms tions-It's all about •Stage II: mild; slight limitation of physical activity; com the impact on fortable at rest; Ordinary physical activity results in the patient's ac- fatigue, palpitation, dyspnea, or anginal pain tivity caused by •Stage III: moderate; marked decrease in physical ac the Heart Failure tivity; marked limitation of physical activity; comfortable symptoms at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain. •Stage IV: severe; inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.
49. heart valve disor- abnormalities in valves between chambers of the heart ders 10 / 32 •Chest pressure upon exercising. •Sustained, laterally displaced apical pulse •Mid- systolic crescendo-decrescendo murmur heard loudest at the base and radiating to the neck. •S4 gallop present
50. Aortic Regurgita- •Shortness of breath that progressively worsens; tion •High-pitched early diastolic murmur heart loudest at the left lower sternal border •Diastolic rumbling sound at the heart's apex and a •Systolic crescendo-decrescendo murmur heard at the left upper sternal border.
51. Murmurs abnormal or unusual heart sounds
52. Aortic Stenosis • Fainting

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57. COPD (chronic •Diagnosis is based on history of symptoms, physical obstructive pul- examination, chest imaging, pulmonary function tests, monary disease) and blood gas analyses. •Pulmonary function testing reveals airway obstruction (decreased FEV1) that is progressive and unresponsive to bronchodilators. •Emphysema •Chronic bronchitis
58. COPD Staging •GOLD 1: Mild: FEV1 e 80% predicted According to •GOLD 2: Moderate: 50% d FEV1 <80% predicted GOLD Guide- •GOLD 3: Severe: 30% d FEV1 < 50% predicted lines- Is Based on •GOLD 4: Very severe: FEV < 30% predicted the degree of airway limitation
59. Emphysema •The damage occurs in the alveoli •Impairs gas exchange •Issue is in expiration-they can get air in but cannot get it out •Air trapping 13 / 32 •Pursed-lip breathing •Increased A&P diameter •Barrel chest
60. signs of emphyse- - dyspnea ma - enlarged chest
61. chronic bronchitis •Productive cough with copious amount of sputum, dys- pnea, wheezing, rhonchi and cyanosis of the skin and mucus membranes •Damage occurs in the airway-not the alveoli
62. Allergic con- Type 4 tact dermatitis Allergic contact dermatitis is an example of a Type IV is an exam- hypersensitivity reaction mediated by T-cells. When the ple of_________hy- individual comes in contact with the antigen (e.g. poison persensitivity reac- ivy), an antigen complex is formed. On subsequent tion. exposure to the antigen, sensitized T-cells activate the inflammatory process that causes the allergic contact dermatitis to appear

• weight loss as disease progresses
• cyanosis usually not seen

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63. Type 2 (Cytotoxic) IGg or IGM hypersensitivity re- The Type 2 hypersensitivity reaction is mediated by IgG actions are mediat- or IgM ed by

14 / 32 Anaphylaxis is a Type 1 _________ hyper- Type 1 hypersensitivity reactions are mediated by IgE sensitivity reaction and mast cells. An individual who is highly sensitized to the antigen may experience anaphylaxis.

65. Which of the fol- Neutrophils lowing are consid- Neutrophils appear first in any immune response ered the "first responders" of the innate immune system?
66. Examples of type II drug allergies, hemolytic anemia, blood transfusion reactions include mismatch with resulting transfusion reaction and Rh hemolytic disease.
67. A Type II 1.tissue-specific hypersensitivity 2.IgG antibody or IgM antibody reaction is____________and usually occurs as a result of happens that cause an___________ antibody or __________ antibody mediated response 68. Type III responses, 1.antigen in the blood or body fluids the antibody binds 2.then circulates to the tissue to the__________ in the blood or body Fluids and ____________ 69. In a Type II re- cell surface sponse, the antibody binds to the antigen on the 15 / 32 70. The type IV 1. cell-mediated responses hypersensitivity 2. lymphocytes and macrophages reactions are known as1.________ _______ _____ and use 2. ___________ and 3. ___________ as primary mediators 71. Which type of aller- Type 2 gic reaction is 1. Tissue-specific destruction or impairment 72. What is an example 1 - ABO incompatibility of a Type 2 allergic 5 - Graves' disease reaction

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86. In a Type III what 1. immune-complex deposition (ICD) causes the Autoim- WHY mune Diseases As the disease progresses a more accumulation of immune-complexes occurs, and when the body becomes overloaded the complexes are deposited in the tissues and cause inflammation as the mononuclear phagocytes, erythrocytes, and complement system fail to remove immune complexes from the blood
87. Damage occurs Complement damages RBC membrane causing cell with ABO incom- lysis. patibility because WHY The damage from ABO incompatibility occurs because of the effects of complement on the RBC membrane that results in RBC lysis
88. Type IV cytotoxic T-Cells. hypersensitivity re- WHY actions are mediat- The Type IV hypersensitivity reaction is mediated by ed by T-cells
89. Which of the fol- Eosinophilia. lowing assessment WHY findings would be Eosinophils are present in the allergic reaction expected in a patient who presents with urticaria
90. An example of a Chronic Granulomatous Disease. primary immunod- WHY eficiency is: Chronic granulomatous disease (CGD) is an example of a primary immunodeficiency 91. An example of a Pneumocystis Carinii. secondary immun- WHY odeficiency is Pneumocystis Carinii is an example of a secondary immunodeficiency. It is caused by something external to the immune system; in this case, a yeast-like fungus. 18 / 32 92. __________is a Malnutrition predominant cause WHY of secondary im- Malnutrition is the predominant cause of secondary mune deficiencies immune deficiencies worldwide worldwide 93. 1.____________ 1. Primary Immunodefeciency __________________ 2. Less are2. __________ 3. Immune SYSTEM common and occur due to a defect of the development of the3. ____________ ____________ 94. 1. 1. Secondary Immundefienciense ________________ 2. Compromise ______________are conditions where the immune system become2.____________ because of somithing else

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95. Primary immunod- 1. B and T cells eficiencies involve 2. Defect in Phagocytes antibodies defien- 3. Deficiency of complement cies of the
96. Seconday immun- 1. Cancer odeficiencies can 2. Effect of a medication be caused by 3. HIV
97. Examples of Prima- - Chronic granulomatous Disease of Childhood ry Immunodeficien- - DiGeorge Syndrome cies - Job Syndrome 19 / 32

• Common Variable Immunodeficiency
• Familial Mediterranean fever

98. Examples of Sec- Human Immunodeficiency Virus ondary Immunode- Pneumocystis Carinii ficiencies Pneumonia Sinus infection Lung cancer
99. Which of the Facial rash confined to the cheeks. following findings can be used to diagnose Systemic Lupus Erythematosus (SLE)?
100. A renal disease Glomerulonephritis. most often associated with autoimmunity is
101. The Antinuclear Antibody (ANA) __________________ _ is positive in 90% of patients diagnosed with Systemic Lupus Erythematosus (SLE)
102. What is an charateristics of a BENIGN Tumor
103. Grow Slowly
104. Well Defined Capsule
105. Not Invasive
106. Well Differentated
107. Low Mitotic (cell division)
108. Does not Metasize
109. What is the charac- 1. Grow Rapidly teristics of a Malig- 2. Not Encapsulated nant Tumor 3. Invasive 20 / 32
110. What is the MAlignant Tumor Classification
     105. What are the 4 stages of Cancer 106. Tumor Staging using TNM (Tumor,Nodes,Metastasis)
     106. With the Tumor STAGING(TNM) what is the stages of T

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Autoantibodies and auto-reactive T-cells against sis of Multiple Scle- brain antigens rosis )?

115. What assessment 1. Inflammation in salivary and lacrimal glands findings would 2. Autoantibodies and auto-reactive T-cells against support a diagno- apoptotic cells 22 / 32 sis of Sjogren's Syndrome
116. What are examples 1. Anemia of Inflamation and Chronic Disease of Normocytic Ane- 2. Heredity Spherocytes mia (Mean Corpus- 3. G6PD Defieciency cular 80-99) 4. Paroxysmal Nocturnal Hemoglobinuria
117. What is examples 1. B12 Deficiency of Macrocytic Ane- 2. Folate Defiency mia (Mean Corpuscualar > 100)
118. What causes ANE- 1. Impared RBC production MIA 2. Excessive Blood Loss
119. Increase RBC Destruction
120. What is the normal Men=4.7-6.1 RBC count for men Women=4.5-5.2 and woment 23 / 32
121. What is normal Men=13.5-17.5 Hemoglobin Lev- Women=12-15. els for Men and Women
122. What is the normal Men=42-45% Hematocrit Lev- Women=37-48% el for men and women
123. The presenting FALSE signs and symp- WHY toms of an autoim- Presenting clinical manifestations of an autoimmune mune disease is similar across all autoimmune diseases TRUE or FALSE disease will depend on the area of the body affected
124. Which of the following indices measures the average size of red blood cells? Mean Corpuscular Volume (MCV)
125. What is examples of Microcytic Ane-
126. Iron Defiency Anemia
127. Siderblasic Anemia mia (Mean Corpus- 3. Thalassemia cular less than 80 4. Anemia of Chronic Disease

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125. Define 1. # of erythrocytes in 1 Cubic mm of whole blood 1. Red Blood Cells 2. Oxygen carrying pigment of red blood cells 2. Hemoglobin 3. volume of cells as a percentage of the total volume 3. Hematocrit of cells and plasma in whole blood.
126. What is the Aver- 1. 80-100 fL age Mean Cell Vol- 2. Average size of RBC ume
127. What is mean cor- 1.32-36% puscular hemoglo-
128. Average concentration of Hemoglobin per erythro bin concentration cyte (MCHC)?
129. What is Reticulo- 1. Immature RBC- Used to assess bone marrow func cyte tion Normal is 3%
130. Anemias can also Hypochromic anemia describes RBCs with less hemo be classified ac- globin than normal. As a result, the RBCs appear pale cording to the color in color (MCHC is low). of the RBCs: Hyperchromic anemia describes RBCs with more hemoglobin than normal. As a result, the RBCs appear a dark hue or red than normal cells (MCHC is high). Normochromic anemia describes RBCs that have a normal amount of hemoglobin. As a result, the RBCs appear neither pale nor dark (MCHC is normal).

24 / 32 mocytic, microcytic, and macrocytic characterizes red blood cells by their_______ lowing is a type of macrocytic anemia? Decreased tissue oxygenation from anemia can manifest as signs and symptoms of the following: Severe fatigue Pallor Weakness Dyspnea Dizziness REDUCTION OF RBC level will decrease blood volume, activating the renin-angiotensin- aldosterone (RAA) system, which promotes fluid retention and movement of interstitial fluid into the capillaries

131. The terms nor- SIZE
132. Which of the following would normocytic- normochromic indicate? The cell is normal in size and normal in hemoglobin level
133. Which of the fol- Vitamin B-12 deficiency.

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142. TRUE 26 / 32

One of the common precipitating factors of folate deficiency is alcohol abuse T OR F

143. Loss of vibratory Posterior and lateral column spinal cord changes due sense in a patient to nerve demyelination. with Vitamin B- 12 WHY deficiency is due to The posterior and lateral columns of the spinal cord are which of the fol- affected, causing a loss of position and vibration sense, lowing pathophysi- ataxia, and spasticity. ological changes
144. A deficiency of Pernicious intrinsic factor will result in_______________ Anemia
145. Macrocytic 1. Megaloblastic: Folate deficiency and vitamin B12 anemias are deficiency categorized 2. Non-megaloblastic: Liver disease, myelodysplastic as___________ syndrome, increased reticulocyte count (hemorrhage) and ____________

146. C

l i n i c a l M a n i f e s t a - 1. F a t i g u e t i o ns of Macrocytic 2. Dyspnea Anemia 3. Loss of weight or appetite

4. Diarrhea
5. Pallar
6. Why does B12 Defi- Pernicious anemia (PA) results from the autoimmune ciency (Pernicious destruction of the gastric parietal cells which decreases Anemia) happen the secretion of intrinsic factor. Intrinsic factor, as you probably recall, binds to B12 in the stomach and travels through the small intestine. When the complex reaches the ileum, it is broken and B12 is absorbed into the blood. 2 7 / 3 2
7. What does a decrease in B12 lead to

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149. Which of the following lab values will be low in a patient with folate deficiency?
150. Which of the following will be elevated in a patient with pernicious anemia?
151. Which of the following lab values are normal for the patient with folate deficiency?
152. Folate Deficiency Lab Values
153. B12 or Pernicious Anemia Lab values B12 is needed for DNA maturation and condensation leads to
154. immature RBCs, 2.lack of functional hemoglobin, and
155. decreased nerve cell myelination Reticulocyte count. MCV. Ferritin. WHY Ferritin level is normal in a patient with folate deficiency. Lab VALUES MCV-High MCHC-NORMAL Reticulocyte Count=LOW Ferritin=NORMAL Folate=LOW Serum b12=Normal to low Lab VALUES MCV-High MCHC-NORMAL Reticulocyte Count=LOW Ferritin=NORMAL Folate=Normal to Low Serum B-12=*LOW 28 / 32
156. In a patient with FOLATE pernicious anemia, ________ lab values can be normal or low?
157. What cause of hemolytic anemia?
     1. Infection ex. Escherichia coli- found in food poisoning outbreaks
     2. Transfussion Reaction-Type 2 Cytotoxic causes a delay reaction
     3. Hemolytic Diseas- New borns (RH incompatibility)
     4. Autoimmune Reaction- Be Congintal or idiopathic5. Drug Induced-drugs exposed to heat and moisture antioxidizes
158. An individual who Hemolytic anemia.
159. Aplastic anemia can be caused by:
     1. Antibiotics and other drugs- PCN, Chloramphenicol, Phenytoin, Diuretics, Antidiabetic drugs, Sulfa drugs
     2. Chemical or radiation exposure-Side effect of cancer treatment (chemotherapy) 3.Viral induced-Hepatitis, Epstein-Barr virus, Cytomegalovirus
     3. Tumors-Multiple Myeloma
     4. Congenital defects-Fanconi's anemia
160. The Reticulocyte count