Anemia and Polycythemia ( Hematology MCQ’s With Answers)
1 According to WHO, anemia is defined as as a hemoglobin level of ?
A. < 14 g/dL in men & < 13 g/dL in women
B. < 13 g/dL in men & < 12 g/dL in women
C. < 12 g/dL in men & < 11 g/dL in women
D. < 11 g/dL in men & < 10 g/dL in women
Explanation:- The World Health Organization (WHO) defines anemia as a hemoglobin level < 13 g/dL in men and < 12 g/dL in women.
2 Hematopoietic stem cell produce which of the following ?
A. Red cells
B. All classes of granulocytes
C. Cells of the immune system
D. All of the above
Explanation:- Stem cells are capable of producing red cells, all classes of granulocytes, monocytes, platelets, and the cells of the immune system.
3 In the absence of erythropoietin (EPO), committed erythroid progenitor cells undergo ?
A. Stunted growth
B. Halting of growth
C. Programmed cell death (apoptosis)
D. Change to other series of hematopoietic cell
Explanation:- For RBC production, EPO is the regulatory hormone. It is required for maintenance of committed erythroid progenitor cells which undergoes programmed cell death (apoptosis) if EPO is absent.
4 How many mature red cells are produced from a pronormoblast ?
A. 1 to 16
B. 16 to 32
C. 32 to 48
D. 48 to 64
Explanation:- Pronormoblast undergoes 4 – 5 cell divisions resulting in the production of 16 – 32 mature RBC’s.
5 Regulation of EPO production is linked to ?
A. O2
B. CO2
C. Red cell mass
D. Hemoglobin concentration
Explanation:- The regulation of EPO production is linked to O2 availability.
6 Which of the following about mature red cell is false ?
A. Diameter is 8 μm
B. Anucleate
C. Discoid in shape
D. None of the above
Explanation:- Mature RBC is 8 μ in diameter, anucleate, discoid in shape, and extremely pliable for it to negotiate microcirculation successfully.
7 What percentage of all circulating RBC’s is replaced daily ?
A. 0.2 to 0.4 %
B. 0.4 to 0.6 %
C. 0.6 to 0.8 %
D. 0.8 to 1%
Explanation:- Since the average red cell lives for 100 – 120 days, normal red cell production results in the daily replacement of 0.8 – 1% of all circulating red cells in the body,
8 Term “erythron” best relates to ?
A. Erythroid / megakaryocyte progenitor
B. Red cell destruction
C. Organ responsible for red cell production
D. Red blood cell mass
Explanation:- The organ responsible for red cell production is called “erythron” which consists of a rapidly proliferating pool of marrow erythroid precursor cells & the mass of mature circulating RBCs.
9 Erythropoietin is a ?
A. Peptide hormone
B. Glycoprotein hormone
C. Steroid hormone
D. None of the above
Explanation:- EPO is a glycoprotein hormone that acts by binding to specific receptors on surface of marrow erythroid precursors, inducing them to proliferate & mature when iron is adequately available.
10 Erythropoietin is produced and released by ?
A. Glomerular capillaries
B. Proximal tubular cells
C. Peritubular capillary lining cells of kidney
D. All of the above
Explanation:- Physiologic regulator of RBC production, glycoprotein hormone EPO, is produced & released by highly specialized epithelial-like peritubular capillary lining cells within kidney.
11 Erythropoietin is also produced by ?
A. Pancreas
B. Spleen
C. Hepatocytes
D. Al of the above
Explanation:- A small amount of EPO is produced by hepatocytes.
12 Key to EPO gene regulation is ?
A. (HIF)-1
B. (EIF)-1
C. (RIF)-1
D. (GIF)-1
Explanation:- Key to EPO gene regulation is hypoxia-inducible factor (HIF)-1.
13 EPO production is increased in ?
A. Anemia
B. Hypoxemia
C. Renal artery stenosis
D. All of the above
Explanation:- The fundamental stimulus for EPO production is the availability of O2 for tissue metabolic needs. Anemia, hypoxemia, or renal artery stenosis can raise EPO production.
14 Normal level of Plasma EPO is ?
A. 10 to 25 U/L
B. 25 to 50 U/L
C. 50 to 75 U/L
D. 75 to 100 U/L
Explanation:- Normal EPO level in plasma is 10 – 25 U/L.
15 Plasma EPO levels increase when hemoglobin falls below ?
A. 10 to 12 g/dL
B. 8 to 10 g/dL
C. 6 to 8 g/dL
D. 4 to 6 g/dL
Explanation:- When the hemoglobin level falls to 12 g/dL, plasma EPO levels increase logarithmically. When hemoglobin concentration falls below 10 – 12 g/dL, plasma EPO levels increase in proportion to the severity of anemia.
16 In circulation, EPO has a half-clearance time of ?
A. 1 to 3 hours
B. 3 to 6 hours
C. 6 to 9 hours
D. 9 to 12 hours
Explanation:- In circulation, EPO has a half-clearance time of 6 – 9 hours.
17 The mean hematocrit value for adult males is ?
A. 42 %
B. 45 %
C. 47 %
D. 49 %
Explanation:- Mean hematocrit value for adult males is 47% (± SD 7) and for adult females is 42% (± 5).
18 Anemia is most often recognized by ?
A. Attendant symptoms
B. Attendant signs
C. Abnormal screening laboratory tests
D. All of the above
Explanation:- Anemia is most often recognized by (incidental) abnormal screening laboratory tests.
19 O2–hemoglobin dissociation curve relates to which of the following ?
A. Claude effect
B. Bohr effect
C. Charles effect
D. Bennet effect
Explanation:- Bohr effect refers to enhanced O2 delivery through changes in O2–hemoglobin dissociation curve mediated by a decreased pH or increased CO2.
20 Signs of vascular instability appear with acute blood loss of ?
A. 5 to 10 % of total blood volume
B. 10 to 15 % of total blood volume
C. 15 to 20 % of total blood volume
D. 20 to 25% of total blood volume
Explanation:- Signs of vascular instability appear with acute losses of 10 – 15% of the total blood volume.
21 Hypovolemic shock results if volume of blood lost is ?
A. > 25 %
B. > 30 %
C. > 35 %
D. > 40 %
Explanation:- If the volume of blood lost is >40% (>2 L in average-sized adult), signs of hypovolemic shock including confusion, dyspnea, diaphoresis, hypotension and tachycardia appear.
22 Intravascular hemolysis with release of free hemoglobin may be associated with ?
A. Acute back pain
B. Acute pain in lower limbs
C. Acute pain in upper limbs
D. Acute headache
Explanation:-Intravascular hemolysis with release of free hemoglobin may be associated with acute back pain, free hemoglobin in the plasma and urine, and renal failure.
23 Which of the following may be associated with autoimmune hemolysis ?
A. Chronic lymphocytic leukemia
B. Infection
C. Rheumatoid arthritis
D. All of the above
Explanation:- Chronic inflammatory states (infection, rheumatoid arthritis, cancer) are associated with mild to moderate anemia, whereas lymphoproliferative disorders (chronic lymphocytic leukemia and certain other B cell neoplasms) may be associated with autoimmune hemolysis.
24 If palmar creases are lighter in color than surrounding skin, hemoglobin level is usually ?
A. < 10 g/dL
B. < 8 g/dL
C. < 6 g/dL
D. < 4 g/dL
Explanation:- If the palmar creases are lighter in color than the surrounding skin with hyperextended hand, the hemoglobin level is usually < 8 g/dL.
25 Femtoliters is the unit of expression of which of the following ?
A. Mean cell volume (MCV)
B. Mean cell hemoglobin (MCH)
C. Mean concentration of Hb per volume of RBCs (MCHC)
D. None of the above
Explanation:- Mean cell volume (MCV) – femtoliters, mean cell hemoglobin (MCH) – picograms per cell, and mean concentration of hemoglobin per volume of red cells (MCHC) – grams per liter.
26 Which of the following reflects iron supply ?
A. Serum iron
B. Total iron-binding capacity (TIBC)
C. Serum ferritin
D. All of the above
Explanation:- Serum iron, total iron-binding capacity (TIBC), and serum ferritin are measurements of iron supply.
27 Which of the following formula estimates MCV ?
A. (Hematocrit x 10) / (red cell count x 106)
B. (Hemoglobin x 10) / (red cell count x 106)
C. (Hemoglobin x 10) / hematocrit
D. (Hematocrit x 10) / hemoglobin
28 Anisocytosis is related to which feature of RBC ?
A. Size
B. Shape
C. Number
D. Colour
Explanation:- Variations in red cell size is called anisocytosis.
29 Poikilocytosis is related to which feature of RBC ?
A. Size
B. Shape
C. Number
D. Colour
Explanation:- Variations in red cell shape is called poikilocytosis. Poikilocytosis suggests a defect in the maturation of red cell precursors in bone marrow or fragmentation of circulating red cells.
30 RDW correlates with ?
A. Anisocytosis
B. Poikilocytosis
C. Polychromasia
D. All of the above
Explanation:- Degree of anisocytosis correlates with increases in RDW or the range of cell sizes.
31 Upon staining with supravital dye, reticulocytes are identified by what colour of punctate spots ?
A. Red
B. Blue
C. Green
D. Yellow
Explanation:- Reticulocytes are larger red cells, grayish blue in color on Wright-Giemsa stain, that are recently released from bone marrow & their color represents residual amounts of ribosomal RNA.
32 Reliable estimate of red cell production is provided by ?
A. EPO levels
B. Reticulocyte count
C. RDW
D. Polychromasia
Explanation:- Reticulocyte count provides a reliable measure of red cell production.
33 “Shift” cells refer to ?
A. Older RBC’s
B. Prematurely released reticulocytes
C. Normoblasts
D. Any of the above
Explanation:- In anemia, polychromatophilic macrocytes in PBF represent prematurely released reticulocytes referred to as “shift” cells.
34 Erythroid cells take about how many days to mature ?
A. 2.5
B. 3.5
C. 4.5
D. 5.5
Explanation:- Erythroid cells take ~4.5 days to mature. At normal hematocrit levels, they are released to the circulation with ~1 day left as reticulocytes.
35 Absolute reticulocyte count is calculated by ?
A. Reticulocyte count x (Hemoglobin ÷ expected hemoglobin)
B. Reticulocyte count x (Hemoglobin + Hematocrit)
C. Reticulocyte count x (Hemoglobin x Hematocrit)
D. Reticulocyte count / (Hemoglobin + Hematocrit)
36 Which of the following about macrocytes is false ?
A. Red cells are larger than a small lymphocyte
B. Well hemoglobinized red cells
C. Often oval shaped
D. None of the above
Explanation:- Macrocytes are red blood cells that are larger than a small lymphocyte and are well hemoglobinized. Often macrocytes are oval shaped (macro-ovalocytes).
37 Howell-Jolly bodies best relate to which of the following ?
A. Uremia
B. Nuclear remnants
C. Foreign bodies in the circulation
D. All of the above
Explanation:- Howell-Jolly bodies refer to tiny nuclear remnants that are not removed from red cells due to absence of a functional spleen (splenectomy) and and with maturation/dysplastic disorders (excess production). They remain as small homogeneously staining blue inclusions on Wright stain.
38 Teardrop-shaped red cells best relates to ?
A. Uremia
B. Myelofibrosis
C. Thalassemia
D. Liver disease
Explanation:- Teardrop-shaped red cells are seen in myelofibrosis and extramedullary hematopoiesis.
39 Target red cells best relates to ?
A. Uremia
B. Myelofibrosis
C. Thalassemia
D. Acute hemolysis
Explanation:- Target red cells have a bull’s-eye appearance & are seen in thalassemia and liver disease.
40 Target cells are seen in ?
A. Liver disease
B. Thalassemia
C. Hemoglobin C disease
D. All of the above
Explanation:- Target cells are recognized by the bull’s-eye appearance of the red cell. Small numbers of target cells are seen with liver disease & thalassemia. Larger numbers are typical of hemoglobin C disease.
41 Thermal injury may produce which of the following ?
A. Target cells
B. Burr cells
C. Howell-Jolly bodies
D. Red cell fragmentation
Explanation:- Presence of foreign bodies in the circulation (mechanical heart valves), or thermal injury may cause red cell fragmentation.
42 Burr cells are also called ?
A. Echinocytes
B. Acanthocytes
C. Elliptocytes
D. Spherocytes
Explanation:- Burr cells are also called echinocytes. Echinocytes have small, uniform, and evenly spaced membrane projections.
43 Echinocytes are found in patients with ?
A. Severe uremia
B. Glycolytic red cell enzyme defects
C. Microangiopathic hemolytic anemia
D. All of the above
Explanation:- Echinocytes are found in patients with severe uremia, in glycolytic red cell enzyme defects, and in microangiopathic hemolytic anemia.
44 Acanthocytes are present in which of the following conditions ?
A. Severe liver disease
B. Abetalipoproteinemia
C. Patients with McLeod blood group
D. All of the above
Explanation:- Acanthocytes are contracted dense cells with irregular membrane projections that vary in length and width. Acanthocytes are present in severe liver disease, in patients with abetalipoproteinemia, and in rare patients with McLeod blood group.
45 The normal serum iron range is ?
A. 10 to 50 μg / dL
B. 50 to 150 μg / dL
C. 150 to 250 μg / dL
D. 250 to 450 μg / dL
Explanation:- Normal serum iron ranges from 50 – 150 μg/dL
46 The normal serum TIBC range is ?
A. 100 to 150 μg / dL
B. 150 to 300 μg / dL
C. 300 to 360 μg / dL
D. 350 to 450 μg / dL
Explanation:- Normal TIBC is 300 – 360 μg/dL.
47 Percent transferrin saturation is calculated by ?
A. (TIBC x 100) ÷ Serum iron
B. (Serum iron + TIBC) ÷ 100
C. (Serum iron x 100) ÷ TIBC
D. (Serum iron ÷ TIBC) x 100
Explanation:- Percent transferrin saturation is derived by dividing serum iron level (x 100) by TIBC. Normal transferrin saturation ranges from 25 – 50%.
48 Adult males have average serum ferritin levels of about ?
A. 10 μg / L
B. 50 μg / L
C. 100 μg / L
D. 200 μg / L
Explanation:- Serum ferritin is used to evaluate total-body iron stores. Adult males have serum ferritin levels that average ~100 μg/L, corresponding to iron stores of ~1 gram. Serum ferritin level of 10 – 15 μg/L represents depletion of body iron stores.
49 Adult females have average serum ferritin levels of about ?
A. 10 μg / L
B. 30 μg / L
C. 60 μg / L
D. 90 μg / L
Explanation:- Adult females have serum ferritin levels averaging 30 μg/L, reflecting lower iron stores (300 mg).
50 Ferritin is also an ?
A. Enzyme
B. Cytokine
C. Chemokine
D. Acute-phase reactant
Explanation:- Ferritin is also an acute-phase reactant.
51 Erythroblasts containing what are called sideroblasts ?
A. Hemosiderin
B. Ferritin
C. Residual RNA
D. All of the above
Explanation:- In bone marrow smears, developing erythroblasts with small ferritin granules are sideroblasts.
52 Hemolysis is most likely cause if reticulocyte production index is more than ?
A. 2.5
B. 3.5
C. 4.5
D. 5.5
Explanation:- Reticulocyte production index of >2.5 indicates that hemolysis is most likely.
53 Which of the following anemias is most frequent ?
A. Hypoproliferative
B. Maturation Disorders
C. Hemoglobinopathies
D. Hemolytic
Explanation:- At least 75% of all cases of anemia are hypoproliferative in nature. Hemolytic disease is among the least common forms of anemia.
54 A hypoproliferative anemia can result from ?
A. Marrow damage
B. Iron deficiency
C. Inadequate EPO stimulation
D. All of the above
Explanation:- Majority of hypoproliferative anemias are due to mild to moderate iron deficiency or inflammation. They result from marrow damage, iron deficiency or inadequate EPO stimulation.
55 Which of the following is the iron regulatory hormone ?
A. Erythropoietin
B. Transferrin
C. Hepcidin
D. All of the above
Explanation:- Hepcidin is the iron regulatory hormone that is increased in inflammation.
56 Nuclear maturation defects of RBC’s result from all except ?
A. Vitamin B12 deficiency
B. Folic acid deficiency
C. Iron deficiency
D. Methotrexate therapy
Explanation:- Nuclear maturation defects result from vitamin B12 or folic acid deficiency, drug damage (methotrexate or alkylating agents), myelodysplasia and alcohol.
57 Cytoplasmic maturation defects of RBC’s result from ?
A. Severe iron deficiency
B. Abnormalities in heme synthesis
C. Abnormalities in globin synthesis
D. Any of the above
Explanation:- Cytoplasmic maturation defects result from ‘severe’ iron deficiency or abnormalities in globin or heme synthesis.
58 Increased red cell mass is present when hematocrit in men is ?
A. > 45 %
B. > 50 %
C. > 55 %
D. > 60 %
Explanation:- PCV >60% in men & >55% in women are invariably associated with an increased red cell mass.
59 Gaisbock’s syndrome relates to ?
A. Spurious polycythemia
B. High altitude polycythemia
C. Ectopic EPO production
D. Familial polycythemia
Explanation:- Gaisbock’s syndrome refers to spurious polycythemia due to a decrease in plasma volume.
60 EPO-producing neoplasms include ?
A. Hepatoma
B. Uterine leiomyoma
C. Cerebellar hemangiomas
D. All of the above
Explanation:- EPO-producing neoplasms include hepatoma, uterine leiomyoma, renal cancer or cysts and cerebellar hemangiomas.
