Hematology Actual Questions and Correct Answers
Q1
Iron Deficiency Anemia (IDA)
Answer: ↓ Iron → ↓ Hb synthesis; ↓ Serum iron, ↑ TIBC, ↓ Ferritin, ↑ RDW; Iron
studies, Bone marrow (↓ stores, no hemosiderin), Retic count low; Ferritin best single
marker; microcytic, hypochromic; pencil cells
Q2
Anemia of Chronic Inflammation (ACI)
Answer: Iron trapped in macrophages due to ↑ hepcidin; ↓ Iron, ↓ TIBC, ↑ Ferritin,
Normal/↓ Retic; CRP, ESR, Hepcidin level (↑); Associated with inflammation, infection,
malignancy
Q3
Thalassemia (α or β)
Answer: ↓ Globin chain synthesis; MCV ↓ (<75 fL), RBC count ↑, target cells;
Hemoglobin electrophoresis: ↑ HbA₂ (β⁺), ↑ HbF (β⁰) DNA analysis for α/β gene
deletions; Normal iron studies; Mentzer Index < 13
Q4
Sideroblastic Anemia
Answer: Defective heme synthesis → Fe trapped in mitochondria; ↑ Iron, ↑ Ferritin,
Normal/↓ TIBC; Bone marrow Prussian blue: Ringed sideroblasts; May be congenital
(ALAS2) or acquired (lead, drugs, EtOH)
Q5
Lead Poisoning
Answer: Inhibits δ-ALA dehydratase and ferrochelatase; Basophilic stippling, ↑
FEP/ZPP; Zinc protoporphyrin (ZPP) test; Microcytic, hypochromic; neurologic signs
Q6
Megaloblastic Anemia (B₁₂ or Folate)
Answer: Defective DNA synthesis; ↑ MCV (>100 fL), hypersegmented neutrophils;
Serum B₁₂ / Folate, Methylmalonic acid, Homocysteine; Macro-ovalocytes, Howell-Jolly
bodies; normal iron
, Q7
Pernicious Anemia
Answer: Autoimmune loss of intrinsic factor; ↓ B₁₂, ↑ MMA & homocysteine; IF
antibody, Parietal cell antibody tests; May be associated with other autoimmune
diseases
Q8
Aplastic Anemia
Answer: Bone marrow failure / hypocellularity; Pancytopenia, ↓ Retic; Bone marrow
biopsy (fatty, hypocellular), Chromosomal breakage (Fanconi); CD34 ↓ (stem cells);
CD25, CD69 on abnormal clones in some
Q9
Fanconi Anemia (Congenital Aplastic)
Answer: DNA repair defect; Macrocytosis + Pancytopenia; Chromosomal breakage test
(DEB / MMC); Associated skeletal & pigment defects
Q10
Pure Red Cell Aplasia (PRCA)
Answer: Selective RBC aplasia; Normocytic anemia, ↓ Retic, normal WBC/Plt; Bone
marrow: erythroid hypoplasia; May be autoimmune or viral (Parvovirus B19)
Q11
Parvovirus B19-related Anemia
Answer: Viral suppression of erythropoiesis; ↓ Retic, normal WBC/Plt; Parvovirus B19
IgM / PCR; "Slapped cheek" rash in children; transient aplasia in sickle pts
Q12
Hereditary Spherocytosis (HS)
Answer: Membrane spectrin/ankyrin defect → spherocytes; ↑ MCHC, ↑ Retic,
spherocytes; Osmotic fragility test, Eosin-5-maleimide (EMA) binding by flow; DAT
negative; Splenomegaly common
Q1
Iron Deficiency Anemia (IDA)
Answer: ↓ Iron → ↓ Hb synthesis; ↓ Serum iron, ↑ TIBC, ↓ Ferritin, ↑ RDW; Iron
studies, Bone marrow (↓ stores, no hemosiderin), Retic count low; Ferritin best single
marker; microcytic, hypochromic; pencil cells
Q2
Anemia of Chronic Inflammation (ACI)
Answer: Iron trapped in macrophages due to ↑ hepcidin; ↓ Iron, ↓ TIBC, ↑ Ferritin,
Normal/↓ Retic; CRP, ESR, Hepcidin level (↑); Associated with inflammation, infection,
malignancy
Q3
Thalassemia (α or β)
Answer: ↓ Globin chain synthesis; MCV ↓ (<75 fL), RBC count ↑, target cells;
Hemoglobin electrophoresis: ↑ HbA₂ (β⁺), ↑ HbF (β⁰) DNA analysis for α/β gene
deletions; Normal iron studies; Mentzer Index < 13
Q4
Sideroblastic Anemia
Answer: Defective heme synthesis → Fe trapped in mitochondria; ↑ Iron, ↑ Ferritin,
Normal/↓ TIBC; Bone marrow Prussian blue: Ringed sideroblasts; May be congenital
(ALAS2) or acquired (lead, drugs, EtOH)
Q5
Lead Poisoning
Answer: Inhibits δ-ALA dehydratase and ferrochelatase; Basophilic stippling, ↑
FEP/ZPP; Zinc protoporphyrin (ZPP) test; Microcytic, hypochromic; neurologic signs
Q6
Megaloblastic Anemia (B₁₂ or Folate)
Answer: Defective DNA synthesis; ↑ MCV (>100 fL), hypersegmented neutrophils;
Serum B₁₂ / Folate, Methylmalonic acid, Homocysteine; Macro-ovalocytes, Howell-Jolly
bodies; normal iron
, Q7
Pernicious Anemia
Answer: Autoimmune loss of intrinsic factor; ↓ B₁₂, ↑ MMA & homocysteine; IF
antibody, Parietal cell antibody tests; May be associated with other autoimmune
diseases
Q8
Aplastic Anemia
Answer: Bone marrow failure / hypocellularity; Pancytopenia, ↓ Retic; Bone marrow
biopsy (fatty, hypocellular), Chromosomal breakage (Fanconi); CD34 ↓ (stem cells);
CD25, CD69 on abnormal clones in some
Q9
Fanconi Anemia (Congenital Aplastic)
Answer: DNA repair defect; Macrocytosis + Pancytopenia; Chromosomal breakage test
(DEB / MMC); Associated skeletal & pigment defects
Q10
Pure Red Cell Aplasia (PRCA)
Answer: Selective RBC aplasia; Normocytic anemia, ↓ Retic, normal WBC/Plt; Bone
marrow: erythroid hypoplasia; May be autoimmune or viral (Parvovirus B19)
Q11
Parvovirus B19-related Anemia
Answer: Viral suppression of erythropoiesis; ↓ Retic, normal WBC/Plt; Parvovirus B19
IgM / PCR; "Slapped cheek" rash in children; transient aplasia in sickle pts
Q12
Hereditary Spherocytosis (HS)
Answer: Membrane spectrin/ankyrin defect → spherocytes; ↑ MCHC, ↑ Retic,
spherocytes; Osmotic fragility test, Eosin-5-maleimide (EMA) binding by flow; DAT
negative; Splenomegaly common
