HEMATOLOGY STUDY GUIDE Questions & Answers
| Blood Disorders & Laboratory Medicine Review
Latest Update 2026 QUESTIONS WITH RATIONALE
SECTION 1: IRON DEFICIENCY ANEMIA (Questions 1-15)
QUESTION 1:
A 34-year-old female presents with fatigue, pallor, and brittle nails.
Laboratory findings reveal: Hb 9.2 g/dL, MCV 72 fL, MCH 24 pg, ferritin 8
ng/mL, and elevated TIBC. Which of the following is the MOST likely
diagnosis?
A) Thalassemia minor
B) Sideroblastic anemia
C) Iron deficiency anemia
D) Anemia of chronic disease
Rationale: Iron deficiency anemia is characterized by microcytic (low MCV),
hypochromic (low MCH) cells with low ferritin and elevated TIBC. The low
ferritin (<15 ng/mL) is the most specific indicator of depleted iron stores.
Thalassemia minor would show normal or elevated ferritin. Sideroblastic
anemia would show elevated ferritin. Anemia of chronic disease typically
shows normal to high ferritin.
QUESTION 2:
A patient with iron deficiency anemia is started on oral iron supplementation.
Which of the following statements regarding iron absorption is CORRECT?
A) Iron is best absorbed when taken with dairy products
B) Iron is best absorbed on an empty stomach
C) Iron absorption is enhanced by tea consumption
D) Iron is primarily absorbed in the large intestine
,Rationale: Iron is best absorbed in the duodenum and proximal jejunum on
an empty stomach. Calcium (dairy) and tannins (tea) inhibit iron absorption.
Vitamin C enhances absorption. The acidic environment of the stomach
facilitates iron absorption.
QUESTION 3:
Which laboratory finding is MOST characteristic of iron deficiency anemia?
A) Elevated MCV with elevated ferritin
B) Microcytic, hypochromic cells with low ferritin
C) Macrocytic cells with normal ferritin
D) Normocytic cells with elevated ferritin
Rationale: Iron deficiency anemia classically presents with microcytic (MCV
<80 fL), hypochromic (MCH <27 pg) red blood cells and low serum ferritin
(<15 ng/mL). This combination is highly specific for iron deficiency.
QUESTION 4:
A 28-year-old woman reports fatigue for the past 4-6 weeks. Her CBC shows
Hb 10.5 g/dL, MCV 75 fL, ferritin 10 ng/mL. Based on her most likely
diagnosis, for best absorption of nutritional supplement, it should be taken:
A) With milk
B) On an empty stomach
C) With high-fiber foods
D) With coffee
Rationale: Iron supplements are best absorbed on an empty stomach,
approximately 1 hour before or 2 hours after meals. Food, particularly dairy
and high-fiber foods, can reduce iron absorption by up to 50%.
QUESTION 5:
A 45-year-old woman with menorrhagia is diagnosed with iron deficiency
anemia. Which of the following would you expect to see on her peripheral
blood smear?
,A) Macro-ovalocytes
B) Schistocytes
C) Microcytes and hypochromic cells
D) Spherocytes
Rationale: Iron deficiency anemia results in microcytic, hypochromic red
blood cells due to decreased hemoglobin synthesis. Target cells may also be
seen. Macro-ovalocytes are seen in megaloblastic anemia, schistocytes in
hemolytic anemia, and spherocytes in hereditary spherocytosis.
QUESTION 6:
In iron deficiency anemia, which of the following is the EARLIEST laboratory
abnormality to appear?
A) Decreased hemoglobin
B) Decreased MCV
C) Decreased ferritin
D) Increased RDW
Rationale: Ferritin reflects body iron stores. In early iron deficiency, ferritin
decreases before hemoglobin drops or MCV changes. It is the most sensitive
and earliest indicator of iron deficiency.
QUESTION 7:
A patient with iron deficiency anemia may exhibit which of the following
physical findings?
A) Jaundice
B) Koilonychia (spoon nails)
C) Leg ulcers
D) Splenomegaly
Rationale: Koilonychia (spoon-shaped nails) is a classic finding in chronic
iron deficiency anemia. Jaundice suggests hemolysis, leg ulcers suggest sickle
cell disease, and splenomegaly can be seen in various hemolytic anemias.
, QUESTION 8:
Which of the following conditions is MOST commonly associated with iron
deficiency anemia in adults?
A) Vitamin B12 deficiency
B) Chronic gastrointestinal blood loss
C) Folate deficiency
D) Aplastic anemia
Rationale: In adults, chronic blood loss is the most common cause of iron
deficiency anemia. In premenopausal women, menorrhagia is common. In
older adults, gastrointestinal bleeding (e.g., from peptic ulcer, colon cancer)
must be ruled out.
QUESTION 9:
A CBC shows: WBC 6.5 × 10³/μL, Hb 11.0 g/dL, Hct 33%, MCV 70 fL, MCH 23
pg, RDW 18%. What is the MOST likely diagnosis?
A) Thalassemia trait
B) Iron deficiency anemia
C) Folate deficiency
D) Aplastic anemia
Rationale: Elevated RDW (red cell distribution width) along with microcytic,
hypochromic cells is characteristic of iron deficiency anemia. In thalassemia
trait, RDW is often normal despite microcytosis.
QUESTION 10:
A 60-year-old male with iron deficiency anemia and guaiac-positive stool
requires further evaluation. Which of the following is the MOST appropriate
next step?
A) Iron supplementation only
B) Colonoscopy
C) Upper endoscopy only
D) CT abdomen
| Blood Disorders & Laboratory Medicine Review
Latest Update 2026 QUESTIONS WITH RATIONALE
SECTION 1: IRON DEFICIENCY ANEMIA (Questions 1-15)
QUESTION 1:
A 34-year-old female presents with fatigue, pallor, and brittle nails.
Laboratory findings reveal: Hb 9.2 g/dL, MCV 72 fL, MCH 24 pg, ferritin 8
ng/mL, and elevated TIBC. Which of the following is the MOST likely
diagnosis?
A) Thalassemia minor
B) Sideroblastic anemia
C) Iron deficiency anemia
D) Anemia of chronic disease
Rationale: Iron deficiency anemia is characterized by microcytic (low MCV),
hypochromic (low MCH) cells with low ferritin and elevated TIBC. The low
ferritin (<15 ng/mL) is the most specific indicator of depleted iron stores.
Thalassemia minor would show normal or elevated ferritin. Sideroblastic
anemia would show elevated ferritin. Anemia of chronic disease typically
shows normal to high ferritin.
QUESTION 2:
A patient with iron deficiency anemia is started on oral iron supplementation.
Which of the following statements regarding iron absorption is CORRECT?
A) Iron is best absorbed when taken with dairy products
B) Iron is best absorbed on an empty stomach
C) Iron absorption is enhanced by tea consumption
D) Iron is primarily absorbed in the large intestine
,Rationale: Iron is best absorbed in the duodenum and proximal jejunum on
an empty stomach. Calcium (dairy) and tannins (tea) inhibit iron absorption.
Vitamin C enhances absorption. The acidic environment of the stomach
facilitates iron absorption.
QUESTION 3:
Which laboratory finding is MOST characteristic of iron deficiency anemia?
A) Elevated MCV with elevated ferritin
B) Microcytic, hypochromic cells with low ferritin
C) Macrocytic cells with normal ferritin
D) Normocytic cells with elevated ferritin
Rationale: Iron deficiency anemia classically presents with microcytic (MCV
<80 fL), hypochromic (MCH <27 pg) red blood cells and low serum ferritin
(<15 ng/mL). This combination is highly specific for iron deficiency.
QUESTION 4:
A 28-year-old woman reports fatigue for the past 4-6 weeks. Her CBC shows
Hb 10.5 g/dL, MCV 75 fL, ferritin 10 ng/mL. Based on her most likely
diagnosis, for best absorption of nutritional supplement, it should be taken:
A) With milk
B) On an empty stomach
C) With high-fiber foods
D) With coffee
Rationale: Iron supplements are best absorbed on an empty stomach,
approximately 1 hour before or 2 hours after meals. Food, particularly dairy
and high-fiber foods, can reduce iron absorption by up to 50%.
QUESTION 5:
A 45-year-old woman with menorrhagia is diagnosed with iron deficiency
anemia. Which of the following would you expect to see on her peripheral
blood smear?
,A) Macro-ovalocytes
B) Schistocytes
C) Microcytes and hypochromic cells
D) Spherocytes
Rationale: Iron deficiency anemia results in microcytic, hypochromic red
blood cells due to decreased hemoglobin synthesis. Target cells may also be
seen. Macro-ovalocytes are seen in megaloblastic anemia, schistocytes in
hemolytic anemia, and spherocytes in hereditary spherocytosis.
QUESTION 6:
In iron deficiency anemia, which of the following is the EARLIEST laboratory
abnormality to appear?
A) Decreased hemoglobin
B) Decreased MCV
C) Decreased ferritin
D) Increased RDW
Rationale: Ferritin reflects body iron stores. In early iron deficiency, ferritin
decreases before hemoglobin drops or MCV changes. It is the most sensitive
and earliest indicator of iron deficiency.
QUESTION 7:
A patient with iron deficiency anemia may exhibit which of the following
physical findings?
A) Jaundice
B) Koilonychia (spoon nails)
C) Leg ulcers
D) Splenomegaly
Rationale: Koilonychia (spoon-shaped nails) is a classic finding in chronic
iron deficiency anemia. Jaundice suggests hemolysis, leg ulcers suggest sickle
cell disease, and splenomegaly can be seen in various hemolytic anemias.
, QUESTION 8:
Which of the following conditions is MOST commonly associated with iron
deficiency anemia in adults?
A) Vitamin B12 deficiency
B) Chronic gastrointestinal blood loss
C) Folate deficiency
D) Aplastic anemia
Rationale: In adults, chronic blood loss is the most common cause of iron
deficiency anemia. In premenopausal women, menorrhagia is common. In
older adults, gastrointestinal bleeding (e.g., from peptic ulcer, colon cancer)
must be ruled out.
QUESTION 9:
A CBC shows: WBC 6.5 × 10³/μL, Hb 11.0 g/dL, Hct 33%, MCV 70 fL, MCH 23
pg, RDW 18%. What is the MOST likely diagnosis?
A) Thalassemia trait
B) Iron deficiency anemia
C) Folate deficiency
D) Aplastic anemia
Rationale: Elevated RDW (red cell distribution width) along with microcytic,
hypochromic cells is characteristic of iron deficiency anemia. In thalassemia
trait, RDW is often normal despite microcytosis.
QUESTION 10:
A 60-year-old male with iron deficiency anemia and guaiac-positive stool
requires further evaluation. Which of the following is the MOST appropriate
next step?
A) Iron supplementation only
B) Colonoscopy
C) Upper endoscopy only
D) CT abdomen
