Hematology MCQ’s ( iron Deficiency and Other Hypoproliferative Anemias )
252 Which of the following is false about hypoproliferative anemias ?
A. Normocytic RBC’s
B. Normochromic RBC’s
C. Reticulocyte index < 2.0 – 2.5
D. None of the above
Explanation:- Anemias associated with normocytic and normochromic red cells and an inappropriately low reticulocyte response (reticulocyte index < 2.0 – 2.5) are hypoproliferative anemias.
253 Which of the following is a hypoproliferative anemia ?
A. Anemia of acute and chronic inflammation
B. Anemia of hypometabolic states
C. Anemias from marrow damage
D. All of the above
Explanation:- Hypoproliferative anemias include early iron deficiency, acute and chronic inflammation, renal disease, hypometabolic states (protein malnutrition & endocrine deficiencies), and anemias from marrow damage.
254 Most common anemia among hypoproliferative anemias is ?
A. Anemias associated with renal disease
B. Anemias associated with chronic inflammation
C. Anemias associated with cancer
D. Anemias associated with hypometabolic states
Explanation:- anemia associated with chronic inflammation is the most common of the above mentioned hypoproliferative anemias. All these are characterized by an abnormal erythropoietin response to the anemia.
255 Which of the following is called iron transport protein ?
A. Ferritin
B. Transferrin
C. Divalent metal transporter 1 (DMT1)
D. All of the above
Explanation:- Iron absorbed from the diet or released from stores circulates in the plasma bound to transferrin, the iron transport protein.
256 Turnover or half-clearance time of transferrin-bound iron is ?
A. 5 – 10 minutes
B. 10 – 30 minutes
C. 30 – 60 minutes
D. 60 – 90 minutes
Explanation:- Turnover or half-clearance time of transferrin-bound iron is 60 – 90 minutes.
257 Which of the following has the highest affinity for transferrin receptors ?
A. Monoferric transferrin
B. Diferric transferrin
C. Apotransferrin
D. All of the above
Explanation:- Iron-transferrin complex in plasma interacts with specific transferrin receptors on marrow erythroid cell surface. Diferric transferrin has the highest affinity for transferrin receptors. Apotransferrin does not carry iron and has very little affinity for transferrin receptors.
258 Daily requirement of dietary iron in adult man is ?
A. 1 mg
B. 2 mg
C. 3 mg
D. 4 mg
Explanation:- Normally, an adult male needs ~1 mg of elemental iron daily, while females in childbearing years need 1.4 mg/day.
259 During the last two trimesters of pregnancy, daily iron requirements increase to ?
A. 2 to 3 mg
B. 3 to 4 mg
C. 4 to 5 mg
D. 5 to 6 mg
Explanation:- During the last two trimesters of pregnancy, daily iron requirements increase to 5 – 6 mg/day.
260 Transferrin-receptor complex is internalized via ?
A. Etharin-coated pits
B. Megalin-coated pits
C. Clathrin-coated pits
D. Azalin-coated pits
Explanation:- Transferrin-receptor complex is internalized via clathrin-coated pits and transported to an acidic endosome, where iron is released at a low pH.
261 In erythroid cell, excess iron binds to which of the following to form ferritin ?
A. Apoferritin
B. Transferritin
C. Coferritin
D. Endoferritin
Explanation:- In erythroid cell, excess iron binds to Apoferritin to form ferritin.
262 What proportion of red cells turn over each day ?
A. 0.2 to 0.4 %
B. 0.4 to 0.6 %
C. 0.6 to 0.8 %
D. 0.8 to 1.0 %
Explanation:- Normally, average RBC life span is 120 days. Thus, 0.8 – 1.0 % of red cells turn over each day.
263 Each milliliter of red cells contain how much elemental iron ?
A. 1 mg
B. 2 mg
C. 3 mg
D. 4 mg
Explanation:- Each milliliter of red cells contains 1 mg of elemental iron.
264 Iron absorption takes place largely in ?
A. Stomach
B. Proximal small intestine
C. Distal small intestine
D. Large intestine
Explanation:- Iron absorption takes place largely in proximal small intestinethrough a carefully regulated process.
265 Reduction of ferric (Fe3+) to ferrous (Fe2+) iron at brush border membrane of duodenal enterocytes is done by ?
A. Duodenal hepcidin
B. Duodenal ferroportin
C. Duodenal hephaestin
D. Duodenal cytochrome B (Dcytb)
Explanation:- Dietary inorganic iron traverses brush border membrane of duodenal enterocytes via DMT1 after reduction of ferric (Fe3+) to ferrous (Fe2+) iron by duodenal cytochrome B (Dcytb) – a ferrireductase.
266 Iron transport across the enteric absorptive cell membrane is accomplished by ?
A. Duodenal cytochrome B (Dcytb)
B. Hephaestin
C. Ferroportin
D. Divalent metal transporter 1 (DMT-1)
Explanation:- Iron transport across enteric absorptive cell membrane is achieved by Divalent metal transporter 1 (DMT-1). DMT-1 is a general cation transporter and is also known as natural resistance macrophage-associated protein type 2 (Nramp 2) or DCT-1.
267 Iron in gut cell is transported through its basolateral surface to plasma transferrin through ?
A. Duodenal cytochrome B (Dcytb)
B. Hephaestin
C. Ferroportin (FPN)
D. Divalent metal transporter 1 (DMT-1)
Explanation:- In gut cell, iron may be stored as ferritin or released at basolateral surface to plasma transferrin through membrane-embedded iron exporter, ferroportin (FPN).
268 Which of the following oxidizes iron to ferric form for transferrin binding at the basolateral surface of gut cell ?
A. Duodenal cytochrome B (Dcytb)
B. Hephaestin
C. Ferroportin
D. Divalent metal transporter 1 (DMT-1)
Explanation:- Iron moves from enterocyte into circulation via a process requiring basolateral iron exporter ferroportin (FPN) & iron oxidase hephaestin (Heph) – which oxidizes iron to ferric form for transferrin binding.
269 Hephaestin is similar to which of the following ?
A. Ferritin
B. Erythropoietin
C. C-reactive protein
D. Ceruloplasmin
Explanation:- Hephaestin is similar to ceruloplasmin, the copper-carrying protein.
270 Hepcidin is derived from ?
A. Bone marrow
B. Liver
C. Duodenum
D. Spleen
Explanation:- Hepcidin is a 25-amino-acid peptide made by the liver.
271 Which of the following is called “iron regulatory hormone” ?
A. Ferritin
B. Transferrin
C. Erythropoietin
D. Hepcidin
272 Hepcidin principally acts on which of the following ?
A. Duodenal cytochrome B (Dcytb)
B. Hephaestin
C. Ferroportin
D. Divalent metal transporter 1 (DMT-1)
Explanation:- Hepcidin (principal iron regulatory hormone) is involved in regulation of iron uptake by enterocytes & iron release by RE cells. Hepcidin represses ferroportin at basolateral surface as well as iron release from macrophages & serves as a central regulator of body iron traffic. It is a crucial molecule in iron metabolism, linking body stores with intestinal iron absorption.
273 Hepcidin responds to signals mediated by ?
A. HFE
B. TfR2 (transferrin receptor 2)
C. Hemojuvelin (HJV)
D. All of the above
Explanation:- Hepcidin responds to changes in body iron requirements by signals mediated by HFE, TfR2 & hemojuvelin (HJV). Mutations in the genes encoding HFE, TfR2, hemojuvelin, and hepcidin lead to decreased hepcidin release and increased iron absorption, resulting in hemochromatosis.
274 Bone marrow iron stores are absent when serum ferritin level is ?
A. < 15 μg/L
B. < 25 μg/L
C. < 35 μg/L
D. < 45 μg/L
Explanation:- Bone marrow iron stores are absent when the serum ferritin level is <15 μg/L.
275 Hemoglobin synthesis is impaired when transferrin saturation falls to ?
A. 10 to 15 %
B. 15 to 20 %
C. 20 to 25 %
D. 25 to 30 %
Explanation:- Once the transferrin saturation falls to 15 – 20%, hemoglobin synthesis becomes impaired. This is a period of iron-deficient erythropoiesis. When transferrin saturation is 10 – 15%, hemoglobin & hematocrit begin to fall, reflecting iron-deficiency anemia.
276 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 %
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.
277 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
Explanation:- Hb synthesis is impaired in iron-deficient erythropoiesis and PBF shows microcytic RBCs and hypochromic reticulocytes.
278 Appearance of iron deficiency in an adult male means ?
A. Acute inflammation
B. Chronic inflammation
C. Gastrointestinal blood loss
D. Blood malignancy
279 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
Explanation:- Aa a rule, iron deficiency in adult male means gastrointestinal blood loss until proved otherwise.
280 Which of the following is a sign of advanced tissue iron deficiency ?
A. Fatigue
B. Pallor
C. Reduced exercise capacity
D. Cheilosis
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.
281 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
282 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
283 Normal Transferrin saturation is ?
A. 12 to 18 %
B. 15 to 28 %
C. 25 to 50 %
D. 45 to 70 %
Explanation:- Normal range for serum iron is 50 – 150 μg/dL. Normal range for TIBC is 300 – 360 μg/dL. Transferrin saturation is normally 25 – 50%.
284 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
Explanation:- Transferrin saturation is calculated by as serum iron x 100 ÷ TIBC.
285 Iron deficiency states is present when transferrin saturation is below ?
A. 6 %
B. 10 %
C. 14 %
D. 20 %
Explanation:- Iron-deficiency is associated with transferrin saturation levels < 20 %.
286 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
Explanation:- Serum iron level represents amount of circulating iron bound to transferrin.
287 Adult males have serum ferritin values averaging about ?
A. 100 μg / L
B. 200 μg / L
C. 300 μg / L
D. 400 μg / L
288 Adult females have serum ferritin values averaging about ?
A. 10 μg / L
B. 20 μg / L
C. 30 μg / L
D. 40 μg / L
Explanation:- Serum ferritin level correlates with total body iron stores. Normal value for adult males & females average ~100 and 30 μg/L respectively.
289 Sideroblasts have granules consisting of ?
A. Ferritin
B. Transferrin
C. Glycogen
D. All of the above
290 Sideroblasts are ?
A. Developing erythroblasts
B. Developing myeloblasts
C. Defective erythroblasts
D. Defective myeloblasts
291 Normal percentage of sideroblasts in bone marrow is ?
A. 5 %
B. 10 %
C. 40 %
D. 75 %
292 In ‘ringed sideroblasts’, the accumulation of iron is around ?
A. Cell membrane
B. Nucleus
C. Mitochondria
D. Endoplasmic reticulum
293 Sideroblastic anemia usually points to the diagnosis of ?
A. Aplastic anemia
B. Myelodysplasia
C. Pernicious anemia
D. All of the above
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.
294 Normal value of red cell protoporphyrin is ?
A. < 30 μg/dL
B. < 60 μg/dL
C. < 90 μg/dL
D. < 120 μg/dL
Explanation:- Normal value of red cell protoporphyrin is < 30 μg/dL. Most common causes of increased red cell protoporphyrin levels are absolute or relative iron deficiency and lead poisoning.
295 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
Explanation:- Serum levels of transferrin receptor protein (TRP) is 4 – 9 μg/L. It along with serum ferritin, distinguishes between iron deficiency & anemia of chronic inflammation.
296 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
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.
297 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
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.
298 Elemental iron per day for iron replacement therapy is ?
A. ~ 30 mg
B. ~ 100 mg
C. ~ 200 mg
D. ~ 300 mg
Explanation:- For iron replacement therapy, ~300 mg of elemental iron is given per day.
299 Ideally, oral iron preparations should be taken ?
A. Empty stomach
B. Just before a meal
C. Along with meals
D. Following meals
Explanation:- Since foods may inhibit oral iron absorption, iron preparations should be taken on empty stomach.
300 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
Explanation:- Typically, reticulocyte count begin to increase within 4 – 7 days after initiation of oral iron therapy and peak at 1½ weeks.
301 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
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.
302 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
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).
303 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
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.
304 Endogenous erythropoietin production is inadequate for the degree of anemia in ?
A. Chronic inflammation
B. Renal disease
C. Hypometabolism
D. All of the above
Explanation:- With chronic inflammation, renal disease, or hypometabolism, endogenous EPO production is inadequate for the degree of anemia observed.
305 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
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.
306 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
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.
307 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
Explanation:- A typical unit of packed red cells increases the hemoglobin level by 1 g/dL.
308 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
309 Inadequate erythropoietin response is due to ?
A. Iron depletion
B. Aluminum toxicity
C. Hyperparathyroidism
D. All of the above
Explanation:- A fall in Hb during EPO therapy signifies infection or iron depletion. Aluminum toxicity and hyperparathyroidism can also compromise EPO response.
310 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
Explanation:- Normal blood level of erythropoietin is 20 mU per milliliter.
