问题 多项选择题 案例分析题

患者女性,47岁。头晕、乏力、面色苍白半年余。既往有十二指肠溃疡病史。查体:T36.6℃,P96次/分。贫血貌,皮肤干燥,黏膜无出血点,心肺(-),肝脾不大。实验室检查:RBC2.8×1012/L,Hb61g/L,Hct0.21,RDW20%,WBC7.1×109/L,PLT220×109/L

如果进行外周血形态学显微镜检查,可以见到()。

A.以小细胞为主,红细胞大小不均

B.以大细胞为主,红细胞大小不均

C.红细胞中心淡染区扩大

D.出现大量有核红细胞

E.裂红细胞增多

F.靶型红细胞增多

答案

参考答案:A, C

解析:

1.患者的平均红细胞容积(MCV)为75fl,红细胞容积分布宽度(RDW)为20%,大于<14.6%的参考范围,故为小细胞不均一性贫血。通过RBC、HGB、HCT可以计算出该患者的红细胞参数MCV为75fl,MCH为22pg,MCHC为290g/L,为小细胞低色素性贫血。

2.本病例为小细胞低色素性贫血及小细胞不均一性贫血,多为缺铁性贫血,为血红蛋白合成不足所致,外周血涂片可见:红细胞大小不均,以小细胞为主,红细胞中心淡染区扩大。通过计算可得到MCV为75fl,故可排除答案B;外周血出现有核红细胞多见于溶血性贫血,故可排除答案D;靶型红细胞增多见于靶型红细胞增多症,裂红细胞增多多见于弥散性血管内凝血。

3.缺铁性贫血的骨髓象特点为:骨髓有核细胞增生活跃或明显活跃,以红系增生为主,粒红比例降低。增生的红细胞以中、晚幼红细胞为主,其体积比正常的幼红细胞略小,边缘不整齐,胞浆少,染色偏蓝,核固缩似晚幼红细胞,表明胞浆发育落后于核,细胞核发育较细胞质成熟,表现为"核老质幼"。粒细胞系统比例相对减低,各阶段间比例及形态基本正常。其他系统如巨核细胞系统、单核细胞系统及淋巴细胞系统形态基本正常。

4.本题答案中维生素B测定是巨幼细胞性贫血的诊断指标,血清结合珠蛋白测定是溶血性贫血。

选择题
阅读理解

阅读理解

     Commodities (日用品) are basic materials that are used and traded worldwide. The price of

commodities helps determine how much a business can charge for a product and the profit it can

make. Commodity prices have reached a two-year high since falling sharply during the world financial

crisis.

     Hard commodities are materials like iron ore, oil and gold. Agricultural products are soft

commodities. These include wheat, cotton and rice.

     Economic measures show the world economy is recovering. China and India, for example, have

reported strong growth in manufacturing (制造业). Developed nations have had slower growth.

John James, a business professor at Pace University, says demand in developing economies can push

up prices for commodities like oil and iron ore used for making steel. But, he says, changing currency

values can also influence prices.

     Gold prices have reached record levels in recent months. That means gold dealers must pay more

for the commodity now than they did only a year ago. That affects current prices.

     Not surprisingly, manufacturers want some control over the prices they pay for commodities.

Futures (期货) contracts are agreements between a buyer and a seller to exchange something at a

set price at some time in the future. These contracts let buyers lock in a price for basic materials. But

some traders in futures markets only want to make a profit. They buy or sell contracts depending on

the direction they believe prices will go. These speculators (投机者) get condemned when prices rise,

or fall, too quickly. The United States, Germany and France are looking into ways to limit this kind of

trading.

     Some experts say exporting commodities is not a good path to long-term economic growth. The

United Nations recently reported that the least developed countries must change their economies to

provide good incomes for their citizens. A UN official says the least developed countries need to cut

dependence on commodities and manufacture products for export. He says only this will let them gain

from world trade.

1. How many of the following are soft commodities?

① gold  ②corn  ③ cotton  ④ iron  ⑤ education  

⑥ oil  ⑦ fruits  ⑧ rice⑨ salt  ⑩ vegetables

A. Three.      

B. Four.      

C. Five.          

D. Six.

2. What is the leading factor for this round of growth of commodity prices?

A. The growth of gold prices.  

B. The speculators' seeking higher profits.

C. Growth of demands in developed economies.      

D. Growth in manufacturing in developing nations.

3. The underlined word "condemned" in the last but one paragraph probably means ______.

A. blamed    

B. killed      

C. limited        

D. tolerated

4. What is mainly discussed in the last paragraph?

A. Measures to be taken by the United Nations.

B. Solutions to this problem for developing nations.

C. The disadvantages of high prices of commodities.

D. How to bring down the high prices of commodities.