Acquired anemia MCQs With Answer provide B. Pharm students a focused, exam-oriented way to master pathophysiology, etiology, diagnosis, and pharmacotherapy of non-congenital anemia. This concise collection covers common acquired anemia types — iron deficiency, anemia of chronic disease, hemolytic anemia, aplastic anemia, and drug-induced marrow suppression — emphasizing clinical features, laboratory interpretation (CBC, reticulocyte count, peripheral smear, iron studies), treatment principles (iron, folate, erythropoiesis-stimulating agents, transfusion) and drug interactions. Each question reinforces clinical reasoning and prescription considerations relevant to pharmacy practice. Use these targeted MCQs with answers to strengthen diagnostic skills and therapeutic decision-making for patients with acquired anemia. ‘Now let’s test your knowledge with 50 MCQs on this topic.’
Q1. Which laboratory finding is most characteristic of iron deficiency anemia?
- Low MCV with low ferritin
- High MCV with high ferritin
- Normal MCV with high transferrin saturation
- Low RDW with high ferritin
Correct Answer: Low MCV with low ferritin
Q2. In anemia of chronic disease, which iron parameter is typically decreased?
- Ferritin
- TIBC (total iron-binding capacity)
- Serum iron-binding capacity
- Reticulocyte count
Correct Answer: TIBC (total iron-binding capacity)
Q3. A low reticulocyte count in a patient with anemia suggests:
- Peripheral hemolysis
- Bone marrow hypoproliferation
- Acute blood loss with compensatory response
- Vitamin B12 excess
Correct Answer: Bone marrow hypoproliferation
Q4. Which drug is classically associated with aplastic anemia due to bone marrow suppression?
- Chloramphenicol
- Amoxicillin
- Metformin
- Diphenhydramine
Correct Answer: Chloramphenicol
Q5. Which peripheral smear feature is most consistent with hemolytic anemia?
- Schistocytes (fragmented RBCs)
- Macro-ovalocytes
- Target cells only
- Basophilic stippling only
Correct Answer: Schistocytes (fragmented RBCs)
Q6. A positive direct Coombs (direct antiglobulin) test indicates:
- Immune-mediated hemolysis
- Iron deficiency
- Lead poisoning
- Bone marrow failure
Correct Answer: Immune-mediated hemolysis
Q7. In evaluation of suspected iron deficiency, the single best initial test is:
- Serum ferritin
- Bone marrow iron stain
- Serum B12
- Haptoglobin level
Correct Answer: Serum ferritin
Q8. Which of the following is a common oral iron therapy and its typical elemental iron dose per 325 mg tablet?
- Ferrous sulfate — 65 mg elemental iron
- Ferrous gluconate — 200 mg elemental iron
- Ferric carboxymaltose — 150 mg elemental iron
- Iron dextran oral — 100 mg elemental iron
Correct Answer: Ferrous sulfate — 65 mg elemental iron
Q9. In acute hemolysis, which serum marker is typically decreased?
- Haptoglobin
- Lactate dehydrogenase (LDH)
- Indirect bilirubin
- Reticulocyte count
Correct Answer: Haptoglobin
Q10. Which condition commonly causes microcytic anemia besides iron deficiency?
- Thalassemia trait
- Folate deficiency
- Vitamin B12 deficiency
- Aplastic anemia
Correct Answer: Thalassemia trait
Q11. A patient on chronic hemodialysis with anemia is most likely to benefit from:
- Erythropoiesis-stimulating agent (ESA) therapy
- High-dose oral iron only
- Vitamin B12 injections alone
- Platelet transfusion
Correct Answer: Erythropoiesis-stimulating agent (ESA) therapy
Q12. Which adverse effect is a known risk of erythropoiesis-stimulating agents?
- Increased thromboembolic events
- Severe hypokalemia
- Renal stone formation
- Hypotension
Correct Answer: Increased thromboembolic events
Q13. Which of the following drugs can cause macrocytic anemia by inhibiting folate metabolism?
- Methotrexate
- Penicillin
- Ibuprofen
- Simvastatin
Correct Answer: Methotrexate
Q14. In sideroblastic anemia, bone marrow iron study shows:
- Ring sideroblasts
- Absent iron stores
- Uniform microcytosis without iron
- Megakaryocytic hyperplasia
Correct Answer: Ring sideroblasts
Q15. Which IV iron formulation is preferred when rapid repletion and fewer infusions are needed?
- Ferric carboxymaltose
- Oral ferrous sulfate
- Iron dextran via single small dose
- Ferrous fumarate oral
Correct Answer: Ferric carboxymaltose
Q16. A high RDW (red cell distribution width) most commonly suggests:
- Mixed anemia or evolving iron deficiency
- Stable thalassemia trait
- Pure aplastic anemia
- Chronic kidney disease only
Correct Answer: Mixed anemia or evolving iron deficiency
Q17. Which finding differentiates hemolytic anemia from aplastic anemia?
- Elevated reticulocyte count in hemolysis
- Low bilirubin in hemolysis
- Low LDH in hemolysis
- Decreased MCV in aplastic anemia
Correct Answer: Elevated reticulocyte count in hemolysis
Q18. Drug-induced immune hemolytic anemia is often mediated by:
- Drug-induced antibodies coating RBCs (positive Coombs test)
- Iron chelation
- Decreased erythropoietin production
- Bone marrow fibrosis
Correct Answer: Drug-induced antibodies coating RBCs (positive Coombs test)
Q19. Which laboratory pattern is typical of anemia of chronic disease?
- Low serum iron, low TIBC, normal/high ferritin
- High serum iron, high TIBC, low ferritin
- Low serum iron, high TIBC, low ferritin
- High serum iron, low TIBC, high transferrin saturation
Correct Answer: Low serum iron, low TIBC, normal/high ferritin
Q20. Which of the following is a first-line chelator for iron overload with subcutaneous infusion?
- Deferoxamine
- Deferasirox
- Deferiprone oral
- Dimercaprol
Correct Answer: Deferoxamine
Q21. Peripheral smear with hypersegmented neutrophils suggests which cause of anemia?
- Vitamin B12 or folate deficiency (megaloblastic anemia)
- Iron deficiency anemia
- Hemolytic anemia
- Sideroblastic anemia
Correct Answer: Vitamin B12 or folate deficiency (megaloblastic anemia)
Q22. Which of these medications reduces oral iron absorption and should be separated dosing-wise?
- Proton pump inhibitors (e.g., omeprazole)
- Acetaminophen
- Insulin
- Topical steroid
Correct Answer: Proton pump inhibitors (e.g., omeprazole)
Q23. In immune hemolysis due to warm antibodies, the typical RBC morphology includes:
- Microspherocytes
- Basophilic stippling
- Target cells
- Macro-ovalocytes only
Correct Answer: Microspherocytes
Q24. Chronic blood loss causing iron deficiency in adults most often requires evaluation of:
- Gastrointestinal tract for bleeding
- Bone marrow biopsy first
- Immediate EPO therapy without tests
- Skin biopsy
Correct Answer: Gastrointestinal tract for bleeding
Q25. Which lab value rises earliest after successful treatment of iron deficiency?
- Reticulocyte count
- Ferritin
- Hemoglobin normalizes immediately
- MCV normalizes immediately
Correct Answer: Reticulocyte count
Q26. Which of the following best describes pure red cell aplasia?
- Selective erythroid precursor failure with normal leukocytes and platelets
- Pancytopenia with megakaryocyte hyperplasia
- Hemolysis with high reticulocyte count
- Iron overload with increased ferritin
Correct Answer: Selective erythroid precursor failure with normal leukocytes and platelets
Q27. Which toxin is classically associated with aplastic anemia and bone marrow failure?
- Benzene exposure
- Carbon monoxide
- Lead in paint only
- Cyanide
Correct Answer: Benzene exposure
Q28. For severe symptomatic anemia due to acute blood loss, the immediate treatment is:
- Red blood cell transfusion
- Oral iron only
- Start ESA and wait 2 weeks
- Folic acid supplementation alone
Correct Answer: Red blood cell transfusion
Q29. A patient with chronic liver disease often shows which RBC morphology contributing to anemia?
- Target cells
- Schistocytes exclusively
- Hypersegmented neutrophils only
- Megaloblasts predominantly
Correct Answer: Target cells
Q30. Which laboratory is most specific for intravascular hemolysis?
- Low haptoglobin
- High ferritin
- Low TIBC
- High MCV
Correct Answer: Low haptoglobin
Q31. In patients receiving frequent transfusions, monitoring for which complication is essential?
- Iron overload
- Hypokalemia only
- Vitamin C deficiency only
- Hypernatremia
Correct Answer: Iron overload
Q32. The most appropriate test to confirm paroxysmal nocturnal hemoglobinuria (PNH) is:
- Flow cytometry for CD55/CD59 deficiency
- Direct Coombs test
- Serum ferritin
- Bone marrow aspiration only
Correct Answer: Flow cytometry for CD55/CD59 deficiency
Q33. Which of these is a contraindication to erythropoiesis-stimulating agents?
- Uncontrolled hypertension
- Iron deficiency with low ferritin only
- Mild anemia after chemotherapy with no symptomatic burden
- Stable chronic anemia with normal oxygenation
Correct Answer: Uncontrolled hypertension
Q34. A high serum lactate dehydrogenase (LDH) in anemia suggests:
- Cell lysis such as hemolysis
- Iron deficiency without hemolysis
- Pure folate deficiency only
- Hypersplenism without hemolysis
Correct Answer: Cell lysis such as hemolysis
Q35. Which drug commonly causes hemolysis in G6PD-deficient patients but is more relevant to hereditary hemolysis than acquired anemia?
- Primaquine
- Acetaminophen
- Amoxicillin
- Levothyroxine
Correct Answer: Primaquine
Q36. Which pattern on bone marrow biopsy is typical for aplastic anemia?
- Hypocellular marrow with fatty infiltration
- Hypercellular marrow with ring sideroblasts
- Megakaryocytic hyperplasia only
- Massive iron deposition without hypocellularity
Correct Answer: Hypocellular marrow with fatty infiltration
Q37. Which oral iron counseling point improves absorption?
- Take iron on an empty stomach or with vitamin C
- Take with calcium-rich milk
- Take with proton pump inhibitors
- Avoid taking with vitamin C
Correct Answer: Take iron on an empty stomach or with vitamin C
Q38. Which transfusion threshold is commonly used for asymptomatic hospitalized patients without active bleeding?
- Hb <7 g/dL
- Hb <10 g/dL
- Hb <12 g/dL
- Hb <5 g/dL only
Correct Answer: Hb <7 g/dL
Q39. A drug known to cause megaloblastic anemia by inhibiting DNA synthesis is:
- Azathioprine
- Lisinopril
- Metformin
- Hydrochlorothiazide
Correct Answer: Azathioprine
Q40. Which condition would show low MCV but normal or high ferritin?
- Anemia of chronic disease with functional iron sequestration
- Classic iron deficiency anemia
- Folate deficiency anemia
- Aplastic anemia
Correct Answer: Anemia of chronic disease with functional iron sequestration
Q41. Which oral iron side effect is most commonly reported and affects adherence?
- Gastrointestinal upset and constipation
- Alopecia within hours
- Severe hypertension
- Acute renal failure
Correct Answer: Gastrointestinal upset and constipation
Q42. In hemolytic anemia due to prosthetic heart valves, expected smear finding is:
- Schistocytes from mechanical RBC fragmentation
- Macro-ovalocytes from B12 deficiency
- Basophilic stippling specific to lead only
- Ring sideroblasts only
Correct Answer: Schistocytes from mechanical RBC fragmentation
Q43. Which of the following is the best initial management of warm autoimmune hemolytic anemia?
- Glucocorticoids (e.g., prednisone)
- Immediate iron infusion only
- High-dose vitamin B12 alone
- Deferoxamine chelation
Correct Answer: Glucocorticoids (e.g., prednisone)
Q44. Which laboratory test helps distinguish iron deficiency from anemia of chronic disease when ferritin is borderline?
- Soluble transferrin receptor (sTfR) or transferrin saturation
- PT/INR
- Serum creatinine only
- Urinalysis
Correct Answer: Soluble transferrin receptor (sTfR) or transferrin saturation
Q45. Which oral iron formulation is least likely to cause gastrointestinal irritation?
- Enteric-coated or slow-release ferrous fumarate
- Ferrous sulfate immediate-release high dose
- Liquid iron with sucrose only
- Iron dextran oral
Correct Answer: Enteric-coated or slow-release ferrous fumarate
Q46. Which of the following is true about transfusion-transmitted alloimmunization?
- Repeated transfusions increase risk of developing RBC antibodies
- Alloimmunization prevents iron overload
- It is prevented by taking oral iron
- It only occurs with platelet transfusions
Correct Answer: Repeated transfusions increase risk of developing RBC antibodies
Q47. A patient on long-term phenytoin may develop which acquired anemia mechanism?
- Folate deficiency leading to megaloblastic anemia
- Iron overload from increased absorption
- Hemolysis due to warm antibodies
- Pure red cell aplasia only
Correct Answer: Folate deficiency leading to megaloblastic anemia
Q48. Which medication is an oral iron chelator used for chronic transfusional iron overload?
- Deferasirox
- Deferoxamine (IV/subcut)
- Deferiprone IV only
- Penicillamine
Correct Answer: Deferasirox
Q49. Which of the following lab changes is expected after effective iron therapy for deficiency?
- Increase in hemoglobin after ~2–4 weeks and rise in MCV later
- Immediate normalization of ferritin within 24 hours
- Decrease in reticulocyte count after therapy
- Rapid drop in RDW to normal within 2 days
Correct Answer: Increase in hemoglobin after ~2–4 weeks and rise in MCV later
Q50. In a patient with suspected drug-induced marrow suppression, the most useful next step is:
- Review medication history and consider stopping offending drug
- Start high-dose oral iron immediately
- Initiate chronic transfusion program without change
- Prescribe erythropoietin without further assessment
Correct Answer: Review medication history and consider stopping offending drug
