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Thalassemias are a group of inherited blood disorders characterized by the body's overproduction of hemoglobin, leading to various severe symptoms.
Answer: False
Explanation: Thalassemias are characterized by the *reduced* production of hemoglobin, not overproduction, which impairs oxygen transport and leads to various symptoms.
The term 'thalassemia' was first introduced in 1932, replacing the earlier name 'Mediterranean anemia' due to advancements in genetic understanding.
Answer: True
Explanation: The term 'thalassemia' was indeed first used in 1932, replacing 'Mediterranean anemia' as genetic understanding evolved.
In 2015, thalassemia affected approximately 28 million people worldwide and caused 1,680 deaths globally.
Answer: False
Explanation: In 2015, thalassemia affected approximately 280 million people worldwide and was responsible for 16,800 deaths globally, not 28 million and 1,680 deaths.
Having a mild form of alpha thalassemia provides a selective survival advantage against tuberculosis in endemic areas.
Answer: False
Explanation: Having a mild form of alpha thalassemia provides a selective survival advantage against *malaria*, not tuberculosis, in endemic areas.
The Maldives has the world's highest concentration of thalassemia carriers, with 16–18% of its population affected.
Answer: True
Explanation: The Maldives indeed reports the world's highest concentration of thalassemia carriers, with 16–18% of its population affected.
Thomas Benton Cooley first described 'anaemia leucaemic infantum' in 1889, a condition later understood to include thalassemia.
Answer: False
Explanation: Rudolf Von Jaksch first described 'anaemia leucaemic infantum' in 1889. Thomas Benton Cooley made the first definitive identification of a thalassemia in 1925, naming it 'erythroblastic anemia'.
The recessive inheritance pattern of thalassemia was established by American researchers in 1925.
Answer: False
Explanation: The recessive inheritance pattern of thalassemia was established by *Italian* researchers in *1948*, not by American researchers in 1925.
What is the fundamental characteristic of thalassemias as inherited blood disorders?
Answer: A reduced production of hemoglobin, affecting oxygen transport.
Explanation: Thalassemias are fundamentally characterized by a reduced production of hemoglobin, which impairs the red blood cells' ability to transport oxygen effectively throughout the body.
In 2015, how many people worldwide were affected by thalassemia, and how many deaths were attributed to it?
Answer: 280 million affected, 16,800 deaths.
Explanation: According to 2015 data, thalassemia affected approximately 280 million people globally and was responsible for 16,800 deaths worldwide.
Which of the following populations is NOT listed as commonly affected by thalassemia?
Answer: Japanese
Explanation: The listed populations commonly affected by thalassemia include people of Greek, Middle Eastern, South Asian, and African descent. Japanese is not mentioned in this context.
What is the etymological origin of the word 'thalassemia'?
Answer: Greek 'thalassa' (sea) and Neo-Latin suffix '-emia' (blood).
Explanation: The word 'thalassemia' originates from the Greek 'thalassa' (sea) and the Neo-Latin suffix '-emia' (blood), reflecting its initial description in Mediterranean populations.
What evolutionary advantage is conferred by having a mild form of alpha thalassemia?
Answer: Protection against malaria.
Explanation: A mild form of alpha thalassemia provides a selective survival advantage by offering protection against malaria, particularly in endemic regions.
What is the estimated global prevalence of beta-thalassemia carriers?
Answer: Approximately 1.5% of the global population, or 80–90 million people.
Explanation: It is estimated that approximately 1.5% of the global population, equating to 80–90 million individuals, are carriers of beta-thalassemia.
Who made the first definitive identification of a thalassemia in 1925, naming it 'erythroblastic anemia'?
Answer: Thomas Benton Cooley
Explanation: Thomas Benton Cooley made the first definitive identification of a thalassemia in 1925, naming it 'erythroblastic anemia,' which became known as 'Cooley's anemia'.
When was the recessive inheritance pattern of thalassemia established?
Answer: 1948
Explanation: The recessive inheritance pattern of thalassemia was definitively established by Italian researchers in 1948.
Thalassemia is primarily inherited in an X-linked recessive pattern, requiring only one copy of the faulty gene for severe forms to manifest.
Answer: False
Explanation: Thalassemia is inherited in an autosomal recessive pattern, meaning an individual must inherit two copies of the faulty gene (one from each parent) for severe forms to manifest.
Normal human hemoglobin is a tetrameric protein composed of two alpha-like and two beta-like globin chains, each linked to an iron-containing heme component.
Answer: True
Explanation: Normal human hemoglobin is indeed a tetrameric protein, consisting of two alpha-like and two beta-like globin chains, with each chain bound to an iron-containing heme component.
Fetal hemoglobin (HbF) is the predominant hemoglobin type from six months of age, making up 96-97% of total hemoglobin in healthy individuals.
Answer: False
Explanation: Adult hemoglobin (HbA) is predominant from six months of age, constituting 96-97% of total hemoglobin in healthy individuals, while fetal hemoglobin (HbF) declines after birth.
Alpha-globin chains are encoded by two closely linked genes, HBA1 and HBA2, located on chromosome 11.
Answer: False
Explanation: Alpha-globin chains are encoded by the HBA1 and HBA2 genes located on *chromosome 16*, not chromosome 11.
What is the underlying cause of thalassemia, and how is it inherited?
Answer: Genetic disorders, inherited in an autosomal recessive pattern.
Explanation: Thalassemia is caused by genetic disorders and is inherited in an autosomal recessive pattern, requiring two copies of the faulty gene for severe manifestation.
How is normal human hemoglobin structured?
Answer: It is a tetrameric protein with two alpha-like and two beta-like globin chains, each linked to heme.
Explanation: Normal human hemoglobin is structured as a tetrameric protein, consisting of two alpha-like and two beta-like globin chains, with each chain bound to an iron-containing heme component.
What is the primary function of hemoglobin in the human body?
Answer: To transport oxygen from the lungs to other tissues.
Explanation: The primary physiological function of hemoglobin in the human body is to transport oxygen from the lungs to various tissues throughout the body.
On which chromosome are the two closely linked genes (HBA1 and HBA2) that encode the alpha-globin chains located?
Answer: Chromosome 16
Explanation: The two closely linked genes, HBA1 and HBA2, responsible for encoding the alpha-globin chains, are located on chromosome 16.
What is the significance of globin chain balance in normal human hemoglobin?
Answer: It is crucial throughout life to maintain a constant ratio and prevent an excess of either alpha-like or beta-like chains.
Explanation: The balanced synthesis of globin chains is crucial throughout life to maintain a constant ratio of alpha-like and beta-like chains, which is essential for proper oxygen transport and preventing pathological excess of either type.
Alpha thalassemia major is typically fatal to an unborn child because the complete absence of alpha globin prevents the production of functional hemoglobin.
Answer: True
Explanation: Alpha thalassemia major is usually fatal in utero due to the complete absence of alpha globin, which is essential for producing functional hemoglobin, leading to severe oxygen transport impairment.
Thalassemia is classified based on which chain of the hemoglobin molecule is affected, specifically alpha-globin or beta-globin chains.
Answer: True
Explanation: Thalassemias are indeed classified according to whether the alpha-globin or beta-globin chain of the hemoglobin molecule is affected.
In alpha-thalassemia, excess beta chains form hemoglobin H (HbH) in adults, which has a strong affinity for oxygen but fails to release it effectively.
Answer: True
Explanation: In alpha-thalassemia, the imbalance leads to an excess of beta chains, which form unstable hemoglobin H (HbH) in adults. HbH indeed has a high oxygen affinity but is inefficient at releasing oxygen to tissues.
Beta thalassemia major, also known as Cooley anemia, is characterized by the production of some functional beta chains, leading to a milder form of the disease.
Answer: False
Explanation: Beta thalassemia major (Cooley anemia) is caused by a βo/βo genotype, meaning there is a complete absence of functional beta chains and no hemoglobin A production, making it the most severe form, not a milder one.
Delta-thalassemia is a severe form of thalassemia that significantly impacts oxygen transport due to reduced delta and beta globin production.
Answer: False
Explanation: Delta-thalassemia is a rare form characterized by reduced delta and beta globin production, but it generally results in an asymptomatic condition, not a severe one with significant impact on oxygen transport.
Combination hemoglobinopathies involving alpha thalassemia are generally considered benign.
Answer: True
Explanation: Combination hemoglobinopathies that involve alpha thalassemia are typically considered benign, meaning they do not usually lead to severe clinical manifestations.
What is the consequence of an excess of beta chains in alpha-thalassemia in adults?
Answer: Formation of unstable hemoglobin H (HbH), which has strong oxygen affinity but fails to release it.
Explanation: In alpha-thalassemia, an excess of beta chains in adults leads to the formation of unstable hemoglobin H (HbH), which exhibits a strong affinity for oxygen but is inefficient at releasing it to tissues.
Which genotype is associated with Beta thalassemia major, the most severe form of the condition?
Answer: βo/βo
Explanation: Beta thalassemia major, the most severe form, is associated with the βo/βo genotype, indicating a complete absence of functional beta globin chains.
What is the typical clinical presentation of delta-thalassemia?
Answer: An asymptomatic condition.
Explanation: Delta-thalassemia, characterized by reduced delta and beta globin production, typically presents as an asymptomatic condition.
A common symptom of thalassemia is an enlarged spleen, which can become overactive in removing damaged red blood cells.
Answer: True
Explanation: Splenomegaly, an enlarged spleen, is a common symptom in thalassemia patients, as the spleen becomes overactive in removing damaged red blood cells from circulation.
Symptoms of beta thalassemia usually become apparent during the first year of life, coinciding with the increase in fetal hemoglobin production.
Answer: False
Explanation: Symptoms of beta thalassemia typically appear during the first six months of life, coinciding with the *decrease* in fetal hemoglobin (HbF) production, not an increase.
Untreated thalassemia in infants can lead to developmental issues such as slowed growth, delayed puberty, and intellectual impairment.
Answer: True
Explanation: Untreated thalassemia in infants can indeed result in significant developmental problems, including slowed growth, delayed puberty, and intellectual impairment.
Iron overload in thalassemia patients is primarily caused by the body's inability to excrete excess iron, which can damage organs like the heart and liver.
Answer: True
Explanation: Iron overload in thalassemia patients occurs because the body cannot excrete excess iron, leading to its accumulation and potential damage to vital organs such as the heart, liver, and endocrine system.
The immune system in individuals with thalassemia is strengthened due to increased red blood cell production, making them less susceptible to infections.
Answer: False
Explanation: The immune system in individuals with thalassemia is often compromised due to chronic anemia, iron overload, and hypersplenism, increasing their susceptibility to severe infections.
When do symptoms of beta thalassemia typically become apparent in infants?
Answer: During the first six months of life, as fetal hemoglobin declines.
Explanation: Symptoms of beta thalassemia typically manifest during the first six months of life, a period that correlates with the natural decline in fetal hemoglobin (HbF) production.
What is a significant consequence of iron overload in thalassemia patients?
Answer: Damage to organs like the heart, liver, and endocrine system.
Explanation: A significant consequence of iron overload in thalassemia patients is the accumulation of toxic iron in vital organs, leading to damage in the heart, liver, and endocrine system.
Which of the following is a common symptom of thalassemia?
Answer: Enlarged spleen.
Explanation: An enlarged spleen (splenomegaly) is a common physical manifestation and symptom of thalassemia, resulting from the spleen's increased activity in removing damaged red blood cells.
Hematology and Medical Genetics are the two primary medical specialties involved in the diagnosis and treatment of thalassemia.
Answer: True
Explanation: Hematology, focusing on blood disorders, and Medical Genetics, dealing with inherited conditions, are the key specialties in managing thalassemia.
Healthy hemoglobin levels for men are typically between 11.6 and 15 grams per deciliter, while for women, they are between 13.2 and 16.6 grams per deciliter.
Answer: False
Explanation: Healthy hemoglobin levels for men are typically between 13.2 and 16.6 g/dL, and for women, they are between 11.6 and 15 g/dL. The values in the question are reversed.
A routine heel prick test after birth can detect some forms of hemoglobinopathy in newborns.
Answer: True
Explanation: A routine heel prick test performed on newborns can indeed detect certain forms of hemoglobinopathy, including some types of thalassemia.
In beta thalassemia, hemoglobin electrophoresis typically shows increased proportions of HbA2 and HbF relative to HbA.
Answer: True
Explanation: Hemoglobin electrophoresis in beta thalassemia characteristically reveals increased proportions of HbA2 and HbF, relative to HbA, due to the impaired production of beta chains.
A peripheral blood smear from a thalassemia patient typically shows microcytic and hypochromic red blood cells, which are smaller and paler than normal.
Answer: True
Explanation: A peripheral blood smear from a thalassemia patient characteristically reveals microcytic and hypochromic red blood cells, indicating they are smaller and paler than normal erythrocytes.
Which medical specialties are primarily involved in the diagnosis and treatment of thalassemia?
Answer: Hematology and Medical Genetics.
Explanation: The diagnosis and treatment of thalassemia primarily involve the medical specialties of Hematology, due to its impact on blood, and Medical Genetics, given its inherited nature.
What is the typical healthy hemoglobin level range for women?
Answer: 11.6 to 15 grams per deciliter.
Explanation: The typical healthy hemoglobin level range for adult women is between 11.6 and 15 grams per deciliter.
What is the initial step in prenatal screening for hemoglobinopathies according to the source?
Answer: A questionnaire assessing parental health issues and family history.
Explanation: The initial step in prenatal screening for hemoglobinopathies involves a questionnaire to assess parental health issues and family history.
What does a hemoglobin level below 7 g/dl in a complete blood count (CBC) typically indicate in the context of thalassemia diagnosis?
Answer: Thalassemia major.
Explanation: In the context of thalassemia diagnosis, a hemoglobin level below 7 g/dL in a complete blood count (CBC) typically indicates thalassemia major.
How does hemoglobin electrophoresis aid in the diagnosis of beta thalassemia?
Answer: It separates and quantifies different types of hemoglobin, showing increased HbA2 and HbF relative to HbA.
Explanation: Hemoglobin electrophoresis aids in diagnosing beta thalassemia by separating and quantifying different hemoglobin types, typically revealing increased proportions of HbA2 and HbF relative to HbA.
Which of the following is an advanced diagnostic method for precise thalassemia diagnosis and carrier identification?
Answer: High-performance liquid chromatography (HPLC).
Explanation: High-performance liquid chromatography (HPLC) is an advanced and reliable diagnostic method used for precise thalassemia diagnosis and identification of carrier states.
What does a peripheral blood smear from a thalassemia patient typically reveal under oil immersion?
Answer: Microcytic and hypochromic red blood cells.
Explanation: A peripheral blood smear from a thalassemia patient typically reveals microcytic and hypochromic red blood cells, which are characterized by being smaller and paler than normal.
Individuals with thalassemia traits (thalassemia minor) always require ongoing medical treatment and frequent blood transfusions.
Answer: False
Explanation: Individuals with thalassemia traits (thalassemia minor) generally do not require ongoing medical treatment or frequent blood transfusions, although occasional transfusions or folic acid supplementation may be necessary under specific circumstances.
Deferoxamine is an oral iron chelator with common side effects including nausea, vomiting, and diarrhea.
Answer: False
Explanation: Deferoxamine is an iron chelator administered as a daily injection, not orally. Oral iron chelators like deferasirox and deferiprone are associated with gastrointestinal side effects such as nausea, vomiting, and diarrhea.
Luspatercept is a drug that works by inhibiting the maturation of red blood cells, thereby increasing the need for frequent blood transfusions in beta-thalassemia patients.
Answer: False
Explanation: Luspatercept works by *improving* the maturation of red blood cells, which *reduces* the need for frequent blood transfusions in beta-thalassemia patients, not increases it.
Hydroxyurea is a highly effective and certain treatment for alleviating anemia in beta-thalassemia by reactivating fetal hemoglobin production.
Answer: False
Explanation: While Hydroxyurea can reactivate fetal hemoglobin (HbF) production to potentially alleviate anemia in beta-thalassemia, its overall effectiveness for this purpose is considered uncertain, not highly effective and certain.
What is the primary treatment for iron overload resulting from frequent blood transfusions in thalassemia patients?
Answer: Chelation therapy.
Explanation: The primary treatment for iron overload, a common complication of frequent blood transfusions in thalassemia patients, is chelation therapy, which helps remove excess iron from the body.
Which iron chelator is administered as a daily injection and can cause skin reactions and potential hearing loss?
Answer: Deferoxamine
Explanation: Deferoxamine is an iron chelator administered as a daily injection, and its adverse effects include skin reactions at the injection site and potential hearing loss.
How does Luspatercept help treat anemia in adults with beta-thalassemia?
Answer: By improving the maturation of red blood cells, thereby reducing the need for frequent blood transfusions.
Explanation: Luspatercept treats anemia in adults with beta-thalassemia by improving the maturation of red blood cells, which consequently reduces the necessity for frequent blood transfusions.
What is the primary mechanism by which Hydroxyurea potentially alleviates anemia in beta-thalassemia?
Answer: It reactivates the production of fetal hemoglobin (HbF).
Explanation: Hydroxyurea potentially alleviates anemia in beta-thalassemia primarily by reactivating the production of fetal hemoglobin (HbF).
Myeloablation, a preparatory step for all stem cell treatments for thalassemia, involves high doses of chemotherapy to remove faulty HSCs.
Answer: True
Explanation: Myeloablation, involving high doses of chemotherapy, is a necessary preparatory step for all stem cell treatments for thalassemia, aiming to remove the patient's faulty hematopoietic stem cells.
The first successful hematopoietic stem cell transplant for thalassemia was performed in 2014 on a patient with beta thalassemia major.
Answer: False
Explanation: The first successful hematopoietic stem cell transplant for thalassemia was carried out in *1981* on a patient with beta thalassemia major, not 2014.
Gene therapies for thalassemia, which use the patient's own modified stem cells, eliminate the risk of graft-versus-host disease.
Answer: True
Explanation: Gene therapies for thalassemia that use the patient's own modified (autologous) stem cells significantly reduce the risks associated with immune rejection, such as graft-versus-host disease, compared to allogeneic transplantation.
Betibeglogene autotemcel (Zynteglo) and Exagamglogene autotemcel (Casgevy) are two approved gene therapies for alpha thalassemia.
Answer: False
Explanation: Betibeglogene autotemcel (Zynteglo) and Exagamglogene autotemcel (Casgevy) are two approved gene therapies for *beta thalassemia*, not alpha thalassemia.
The American College of Obstetricians and Gynecologists recommends that all individuals considering pregnancy be tested for thalassemia to assess their carrier status.
Answer: True
Explanation: The American College of Obstetricians and Gynecologists (ACOG) indeed recommends that all individuals contemplating pregnancy undergo screening for thalassemia to determine their carrier status.
Cyprus successfully reduced the rate of children born with thalassemia by implementing a comprehensive screening policy that included prenatal screening and abortion.
Answer: True
Explanation: Cyprus successfully reduced the incidence of children born with thalassemia through a comprehensive national screening policy implemented in the 1970s, which included prenatal screening and selective termination of affected pregnancies.
In Iran's premarital screening program, if the man shows microcytosis, the couple is immediately referred for genetic counseling without further testing.
Answer: False
Explanation: In Iran's premarital screening program, if the man shows microcytosis, the *woman is then tested*. Only if both partners are microcytic and have high HbA2 concentrations are they referred for genetic counseling.
What preparatory step is required for all stem cell treatments for thalassemia?
Answer: Myeloablation of the patient's bone marrow using high-dose chemotherapy.
Explanation: Myeloablation of the patient's bone marrow, typically involving high-dose chemotherapy, is a mandatory preparatory step for all stem cell treatments for thalassemia.
When was the first successful Hematopoietic Stem Cell Transplantation (HSCT) for thalassemia carried out?
Answer: 1981
Explanation: The first successful Hematopoietic Stem Cell Transplantation (HSCT) for thalassemia was performed in 1981.
What is a key advantage of gene therapies for thalassemia over traditional HSCT?
Answer: Using the patient's own cells reduces the risks of immune rejection like graft-versus-host disease.
Explanation: A key advantage of gene therapies for thalassemia, particularly those using autologous stem cells, is the significant reduction in risks of immune rejection, such as graft-versus-host disease, compared to allogeneic HSCT.
Which approved gene therapy for beta thalassemia works by adding a healthy beta-globin gene to the patient's HSCs using a lentiviral vector?
Answer: Betibeglogene autotemcel (Zynteglo)
Explanation: Betibeglogene autotemcel (Zynteglo) is an approved gene therapy for beta thalassemia that functions by introducing a healthy beta-globin gene into the patient's hematopoietic stem cells via a lentiviral vector.
What is the recommendation from the American College of Obstetricians and Gynecologists regarding thalassemia prevention?
Answer: All individuals considering pregnancy should be tested for thalassemia to assess carrier status.
Explanation: The American College of Obstetricians and Gynecologists recommends that all individuals considering pregnancy undergo testing for thalassemia to determine their carrier status, facilitating informed reproductive decisions.
How did Cyprus successfully reduce the rate of children born with thalassemia?
Answer: By implementing a comprehensive screening policy including prenatal screening and abortion.
Explanation: Cyprus achieved a significant reduction in the birth rate of children with thalassemia by implementing a comprehensive national screening policy that included prenatal screening and selective termination of affected pregnancies.