[MCQs] Iron Deficiency and Other Hypoproliferative Anemias - Part 2

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Iron Deficiency and Other Hypoproliferative Anemias- Part 2

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Question 1

Which of the following about iron-deficient erythropoiesis is false ?

A	Impaired hemoglobin synthesis
B	Microcytic RBCs first appear in PBF
C	Hyperchromic reticulocytes in circulation
D	Transferrin saturation between 15 to 20 %

Question 1 Explanation:

When transferrin saturation is between 15 to 20%, hemoglobin synthesis is impaired. This is a period of iron-deficient erythropoiesis. Peripheral blood smear reveals the first appearance of microcytic cells and hypochromic reticulocytes in circulation.

Question 2

Microcytic RBC’s & hypochromic reticulocytes first appear in circulation in which of the following stages ?

A	Negative iron balance
B	Iron-deficient erythropoiesis
C	Iron-deficiency anemia
D	All of the above

Question 2 Explanation:

Hb synthesis is impaired in iron-deficient erythropoiesis and PBF shows microcytic RBCs and hypochromic reticulocytes.

Question 3

Appearance of iron deficiency in an adult male means ?

A	Acute inflammation
B	Chronic inflammation
C	Gastrointestinal blood loss
D	Blood malignancy

Question 4

Iron deficiency in adult male usually means ?

A	Inadequate iron in diet
B	Inadequate iron absorption
C	Gastrointestinal blood loss
D	All of the above

Question 4 Explanation:

Aa a rule, iron deficiency in adult male means gastrointestinal blood loss until proved otherwise

Question 5

Which of the following is a sign of advanced tissue iron deficiency ?

A	Fatigue
B	Pallor
C	Reduced exercise capacity
D	Cheilosis

Question 5 Explanation:

Usual signs of iron deficiency anemia are fatigue, pallor & reduced exercise capacity. Cheilosis (fissures at corners of mouth) & koilonychia are signs of advanced tissue iron deficiency.

Question 6

Normal range for serum iron is ?

A	10 to 40 µg / dL
B	20 to 80 µg / dL
C	30 to 100 µg / dL
D	50 to 150 µg / dL

Question 7

Normal range for TIBC is ?

A	180 to 250 µg / dL
B	300 to 360 µg / dL
C	450 to 700 µg / d
D	750 to 1050 µg / dL

Question 8

Normal Transferrin saturation is ?

A	12 to 18 %
B	15 to 28 %
C	25 to 50 %
D	45 to 70 %

Question 9

Which of the following is the formula for calculating transferrin saturation ?

A	(Serum iron x 100) ÷ TIBC
B	(TIBC x 100) + Serum iron
C	(Serum iron - 100) x TIBC
D	(TIBC - 100) x Serum iron

Question 9 Explanation:

Transferrin saturation is calculated by as serum iron x 100 + TIBC.

Question 10

Iron deficiency states is present when transferrin saturation is below ?

A	6 %
B	10 %
C	14 %
D	20 %

Question 10 Explanation:

Iron-deficiency is associated with transferrin saturation levels < 20 %.

Question 11

Serum iron level represents the amount of ?

A	Circulating free iron
B	Circulating iron bound to transferrin
C	Circulating free iron + iron bound to transferrin
D	Any of the above

Question 11 Explanation:

Serum iron level represents amount of circulating iron bound to transferrin

Question 12

Adult males have serum ferritin values averaging about ?

A	100 µg / L
B	200 µg / L
C	300 µg / L
D	400 µg / L

Question 13

Adult females have serum ferritin values averaging about ?

A	10 µg / L
B	20 µg / L
C	30 µg / L
D	40 µg / L

Question 13 Explanation:

Serum ferritin level correlates with total body iron stores. Normal value for adult males & females average ~100 and 30 µg/L respectively.

Question 14

Sideroblasts have granules consisting of ?

A	Ferritin
B	Transferrin
C	Glycogen
D	All of the above

Question 15

Sideroblasts are ?

A	Developing erythroblasts
B	Developing myeloblasts
C	Defective erythroblasts
D	Defective myeloblasts

Question 16

Normal percentage of sideroblasts in bone marrow is ?

A	5 %
B	10 %
C	40 %
D	75 %

Question 17

In ‘ringed sideroblasts’, the accumulation of iron is around ?

A	Cell membrane
B	Nucleus
C	Mitochondria
D	Endoplasmic reticulum

Question 18

Sideroblastic anemia usually points to the diagnosis of ?

A	Aplastic anemia
B	Myelodysplasia
C	Pernicious anemia
D	All of the above

Question 18 Explanation:

Normally, in a bone marrow smear stained for iron, 20 - 40% of developing erythroblasts called sideroblasts are visible with ferritin granules in their cytoplasm. Ringed sideroblasts are seen in myelodysplastic syndromes due to mitochondrial dysfunction. Iron accumulates in mitochondria in a necklace fashion around the nucleus of erythroblast.

Question 19

Normal value of red cell protoporphyrin is ?

A	< 30 pg/dL
B	< 60 pg/dL
C	< 90 pg/dL
D	< 120 pg/dL

Question 19 Explanation:

Normal value of red cell protoporphyrin is < 30 ụg/dL. Most common causes of increased red cell protoporphyrin levels are absolute or relative iron deficiency and lead poisoning.

Question 20

Which of the following is false about transferrin receptor protein (TRP) ?

A	Serum levels of TRP reflect total erythroid marrow mass
B	TRP is released by erythroid cells into circulation
C	TRP levels are elevated in absolute iron deficiency
D	None of the above

Question 20 Explanation:

Serum levels of transferrin receptor protein (TRP) is 4 - 9 pg/L. It along with serum ferritin, distinguishes between iron deficiency & anemia of chronic inflammation.

Question 21

Which of the following is false about thalassemias ?

A	Hypochromic microcytic anemia
B	B. Normal or increased serum iron levels
C	C. Normal or increased serum transferrin saturation
D	D. Elevated red blood cell distribution width (RDW) index

Question 21 Explanation:

Characteristics of thalassemia include hypochromic microcytic anemia, normal or increased serum iron levels & transferrin saturation with small RDW index which is elevated in iron deficiency.

Question 22

Which of the following is false about anemia of chronic inflammation ?

A	Normocytic and normochromic anemia
B	Normal or increased serum ferritin levels
C	Below normal serum transferrin saturation
D	Normal TIBC

Question 22 Explanation:

Anemia of chronic inflammation with inadequate iron supply is normocytic and normochromic. Ferritin level is normal or increased and percent transferrin saturation & TIBC are typically below normal.

Question 23

Elemental iron per day for iron replacement therapy is ?

A	~ 30 mg
B	~ 100mg
C	~ 200mg
D	~ 300mg

Question 23 Explanation:

For iron replacement therapy, ~300 mg of elemental iron is given per day

Question 24

Ideally, oral iron preparations should be taken ?

A	Empty stomach
B	Just before a meal
C	Along with meals
D	Following meals

Question 24 Explanation:

Since foods may inhibit oral iron absorption, iron preparations should be taken on empty stomach

Question 25

How many days after initiation of oral iron therapy, reticulocyte count begin to increase ?

A	4 - 7 days
B	4 - 7 days
C	14 - 21 days
D	21 - 28 days

Question 25 Explanation:

Typically, reticulocyte count begin to increase within 4 - 7 days after initiation of oral iron therapy and peak at 1½ weeks.

Question 26

In normal iron tolerance test, 2 hours after 2 iron tablets, serum iron increases by ?

A	10 µg / dL
B	500 µg / dL
C	75 µg / dL
D	100 µg / dL

Question 26 Explanation:

In normal iron tolerance test, 2 hours after 2 iron tablets on an empty stomach, serum iron increases by at least 100 µg/dL indicating patient’s ability to absorb iron adequately

Question 27

Amount of parenteral iron needed is calculated by ?

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

Question 27 Explanation:

Amount of parenteral iron needed is calculated by weight (kg) x 2.3 x (15 - patients Hb in grams/ dL) + 500 or 1000 mg (for stores).

Question 28

Infusion of iron must be stopped immediately if which of the following develops ?

A	Chest pain
B	Wheezing
C	Fall in blood pressure
D	Any of the above

Question 28 Explanation:

Early in the infusion of iron, if chest pain, wheezing, a fall in blood pressure, or other systemic symptoms occur, the infusion of iron should be stopped immediately

Question 29

Endogenous erythropoietin production is inadequate for the degree of anemia in ?

A	Chronic inflammation
B	Renal disease
C	Hypometabolism
D	All of the above

Question 29 Explanation:

With chronic inflammation, renal disease, or hypometabolism, endogenous EPO production is inadequate for the degree of anemia observed

Question 30

Which of the following is a feature of anemia of chronic disease ?

A	Increased red cell protoporphyrin
B	Hypoproliferative marrow
C	Normal or increased serum ferritin
D	All of the above

Question 30 Explanation:

Features of anemia of chronic disease are a low serum iron, increased red cell protoporphyrin, hypoproliferative marrow, transferrin saturation of 15 - 20%, & normal or increased serum ferritin

Question 31

Which of the following is the most distinguishing feature between true iron-deficiency anemia & iron-deficient erythropoiesis associated with inflammation ?

A	Low serum iron
B	Increased red cell protoporphyrin
C	Normal or increased serum ferritin
D	Hypoproliferative marrow

Question 31 Explanation:

Serum ferritin level is the most distinguishing feature between true iron-deficiency anemia & iron-deficient erythropoiesis associated with inflammation which increase threefold over basal levels in inflammation due to effects of inflammatory cytokines & hepcidin

Question 32

A typical unit of packed RBC increases hemoglobin by ?

A	0.5 g / dL
B	0.75 g / dL
C	1 g / dL
D	1.25 g / dL

Question 32 Explanation:

A typical unit of packed red cells increases the hemoglobin level by 1 g/dL.

Question 33

A unit of packed RBCs contains how much iron ?

A	25 to 30 mg
B	100 to 150 mg
C	150 to 250 mg
D	250 to 300 mg

Question 34

Inadequate erythropoietin response is due to ?

A	Iron depletion
B	Aluminum toxicity
C	Hyperparathyroidism
D	All of the above

Question 34 Explanation:

A fall in Hb during EPO therapy signifies infection or iron depletion. Aluminum toxicity and hyperparathyroidism can also compromise EPO response.

Question 35

Normal blood level of erythropoietin is ?

A	10 mU per milliliter
B	20 mU per milliliter
C	30 mU per milliliter
D	40 mU per milliliter

Question 35 Explanation:

Normal blood level of erythropoietin is 20 mU per milliliter.

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Iron Deficiency and Other Hypoproliferative Anemias – part 1 | Iron Deficiency and Other Hypoproliferative Anemias – part 2

II. Preview all questions below

1. Which of the following about iron-deficient erythropoiesis is false ?
A. Impaired hemoglobin synthesis
B. Microcytic RBCs first appear in PBF
C. Hyperchromic reticulocytes in circulation
D. Transferrin saturation between 15 to 20 %

2. Microcytic RBC’s & hypochromic reticulocytes first appear in circulation in which of the following stages ?
A. Negative iron balance
B. Iron-deficient erythropoiesis
C. Iron-deficiency anemia
D. All of the above

3. Appearance of iron deficiency in an adult male means ?
A. Acute inflammation
B. Chronic inflammation
C. Gastrointestinal blood loss
D. Blood malignancy

4. Iron deficiency in adult male usually means ?
A. Inadequate iron in diet
B. Inadequate iron absorption
C. Gastrointestinal blood loss
D. All of the above

5. Which of the following is a sign of advanced tissue iron deficiency ?
A. Fatigue
B. Pallor
C. Reduced exercise capacity
D. Cheilosis

6. Normal range for serum iron is ?
A. 10 to 40 µg / dL
B. 20 to 80 µg / dL

C. 30 to 100 µg / dL
D. 50 to 150 µg / dL

7. Normal range for TIBC is ?
A. 180 to 250 µg / dL
B. 300 to 360 µg / dL
C. 450 to 700 µg / dL
D. 750 to 1050 µg / dL

8. Normal Transferrin saturation is ?
A. 12 to 18 %
B. 15 to 28 %
C. 25 to 50 %
D. 45 to 70 %

9. Which of the following is the formula for calculating transferrin saturation ?
A. (Serum iron x 100) ÷ TIBC
B. (TIBC x 100) ÷ Serum iron
C. (Serum iron ÷ 100) x TIBC
D. (TIBC ÷ 100) x Serum iron

10. Iron deficiency states is present when transferrin saturation is below ?
A. 6 %
B. 10 %
C. 14 %
D. 20 %

11. Serum iron level represents the amount of ?
A. Circulating free iron
B. Circulating iron bound to transferrin
C. Circulating free iron + iron bound to transferrin
D. Any of the above

12. Adult males have serum ferritin values averaging about ?
A. 100 µg / L
B. 200 µg / L
C. 300 µg / L
D. 400 µg / L

13. Adult females have serum ferritin values averaging about ?
A. 10 µg / L

B. 20 µg / L
C. 30 µg / L
D. 40 µg / L

14. Sideroblasts have granules consisting of ?
A. Ferritin
B. Transferrin
C. Glycogen
D. All of the above

15. Sideroblasts are ?
A. Developing erythroblasts
B. Developing myeloblasts
C. Defective erythroblasts
D. Defective myeloblasts

16. Normal percentage of sideroblasts in bone marrow is ?
A. 5 %
B. 10 %
C. 40 %
D. 75 %

17. In ‘ringed sideroblasts’, the accumulation of iron is around ?
A. Cell membrane
B. Nucleus
C. Mitochondria
D. Endoplasmic reticulum

18. Sideroblastic anemia usually points to the diagnosis of ?
A. Aplastic anemia
B. Myelodysplasia
C. Pernicious anemia
D. All of the above

19. Normal value of red cell protoporphyrin is ?
A. < 30 µg/dL
B. < 60 µg/dL
C. < 90 µg/dL
D. < 120 µg/dL

20. Which of the following is false about transferrin receptor protein (TRP) ?

A. Serum levels of TRP reflect total erythroid marrow mass
B. TRP is released by erythroid cells into circulation
C. TRP levels are elevated in absolute iron deficiency
D. None of the above

21. Which of the following is false about thalassemias ?
A. Hypochromic microcytic anemia
B. Normal or increased serum iron levels
C. Normal or increased serum transferrin saturation
D. Elevated red blood cell distribution width (RDW) index

22. Which of the following is false about anemia of chronic inflammation ?
A. Normocytic and normochromic anemia
B. Normal or increased serum ferritin levels
C. Below normal serum transferrin saturation
D. Normal TIBC

23. Elemental iron per day for iron replacement therapy is ?
A. ~ 30 mg
B. ~ 100 mg
C. ~ 200 mg
D. ~ 300 mg

24. Ideally, oral iron preparations should be taken ?
Harrison’s 18th Ed. 848
A. Empty stomach
B. Just before a meal
C. Along with meals
D. Following meals

25. How many days after initiation of oral iron therapy, reticulocyte count begin to increase ?
A. 4 – 7 days
B. 7 – 14 days
C. 14 – 21 days
D. 21 – 28 days

26. In normal iron tolerance test, 2 hours after 2 iron tablets, serum iron increases by ?

A. 10 µg / dL
B. 500 µg / dL
C. 75 µg / dL
D. 100 µg / dL

27. Amount of parenteral iron needed is calculated by ?
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

28. Infusion of iron must be stopped immediately if which of the following develops ?
A. Chest pain
B. Wheezing
C. Fall in blood pressure
D. Any of the above

29. Endogenous erythropoietin production is inadequate for the degree of anemia in ?
A. Chronic inflammation
B. Renal disease
C. Hypometabolism
D. All of the above

30. Which of the following is a feature of anemia of chronic disease ?
A. Increased red cell protoporphyrin
B. Hypoproliferative marrow
C. Normal or increased serum ferritin
D. All of the above

31. Which of the following is the most distinguishing feature between true iron-deficiency anemia & iron-deficient erythropoiesis associated with inflammation ?
A. Low serum iron
B. Increased red cell protoporphyrin
C. Normal or increased serum ferritin
D. Hypoproliferative marrow

32. A typical unit of packed RBC increases hemoglobin by ?
A. 0.5 g / dL
B. 0.75 g / dL
C. 1 g / dL
D. 1.25 g / dL

33. A unit of packed RBCs contains how much iron ?
Harrison’s 18th Ed. 851
A. 25 to 30 mg
B. 100 to 150 mg
C. 150 to 250 mg
D. 250 to 300 mg

34. Inadequate erythropoietin response is due to ?
Harrison’s 18th Ed. 851
A. Iron depletion
B. Aluminum toxicity
C. Hyperparathyroidism
D. All of the above

35. Normal blood level of erythropoietin is ?
N Engl J Med 2006;354:2034-45
A. 10 mU per milliliter
B. 20 mU per milliliter
C. 30 mU per milliliter
D. 40 mU per milliliter

[MCQs] Iron Deficiency and Other Hypoproliferative Anemias – Part 2

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Iron Deficiency and Other Hypoproliferative Anemias- Part 2

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