Introduction: Hematinics MCQs With Answer are essential for B.Pharm students to master clinical pharmacology of iron, folic acid, vitamin B12 and related drugs used in anemia management. This concise, focused set covers mechanisms (hepcidin, transferrin, ferritin), pharmacokinetics of oral and parenteral iron, elemental iron differences, indications for IV iron, adverse effects, and iron chelators. It also addresses folate and cobalamin biology, laboratory markers (serum ferritin, TIBC, transferrin saturation), drug interactions, and monitoring strategies. Designed to deepen understanding beyond basics, these questions prepare students for exams and practical decision-making in therapeutics. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which statement best defines hematinics?
- Drugs and nutrients that support erythropoiesis such as iron, folic acid and vitamin B12
- Agents that exclusively increase white blood cell count
- Medications that lower serum iron to treat overload
- Only parenteral iron formulations used in hospitals
Correct Answer: Drugs and nutrients that support erythropoiesis such as iron, folic acid and vitamin B12
Q2. What is the principal action of hepcidin in iron homeostasis?
- Increase intestinal iron absorption and release from macrophages
- Decrease intestinal iron absorption and trap iron in macrophages
- Enhance transferrin synthesis in the liver
- Directly stimulate erythropoietin production
Correct Answer: Decrease intestinal iron absorption and trap iron in macrophages
Q3. Which laboratory parameter most accurately reflects total body iron stores?
- Serum ferritin
- Serum iron
- Total iron-binding capacity (TIBC)
- Reticulocyte count
Correct Answer: Serum ferritin
Q4. Which oral iron salt is most commonly recommended as first-line therapy for iron deficiency anemia?
- Ferrous sulfate
- Ferric polymaltose complex
- Iron dextran
- Deferasirox
Correct Answer: Ferrous sulfate
Q5. Which cofactor markedly enhances non-heme iron absorption from the gut?
- Ascorbic acid (vitamin C)
- Calcium
- Phytates
- Polyphenols (tea)
Correct Answer: Ascorbic acid (vitamin C)
Q6. Which common medication class reduces gastric acidity and can impair oral iron absorption?
- Proton pump inhibitors (PPIs)
- Beta-blockers
- Benzodiazepines
- Loop diuretics
Correct Answer: Proton pump inhibitors (PPIs)
Q7. Which oral iron formulation provides the highest percentage of elemental iron by weight?
- Ferrous fumarate (~33% elemental iron)
- Ferrous gluconate (~12% elemental iron)
- Ferrous sulfate (~20% elemental iron)
- Ferric hydroxide polymaltose (~5–10% elemental iron)
Correct Answer: Ferrous fumarate (~33% elemental iron)
Q8. Which clinical scenario is a clear indication for parenteral iron therapy?
- Failure of oral iron due to malabsorption or intolerance
- Mild iron deficiency responding to oral iron
- Routine prevention of anemia in low-risk adults
- Initial therapy for folate deficiency
Correct Answer: Failure of oral iron due to malabsorption or intolerance
Q9. Which parenteral iron formulation has been most associated with serious anaphylactic reactions?
- Iron dextran
- Iron sucrose
- Ferric carboxymaltose
- Sodium ferric gluconate
Correct Answer: Iron dextran
Q10. Which agent is the standard chelator used in acute severe iron poisoning?
- Deferoxamine
- Deferasirox
- Deferiprone
- Phytonadione
Correct Answer: Deferoxamine
Q11. The most common gastrointestinal adverse effect of oral iron therapy is:
- Constipation
- Nephrotoxicity
- Neutropenia
- Hyperglycemia
Correct Answer: Constipation
Q12. Hereditary hemochromatosis is best described as:
- Genetic iron overload due to increased intestinal absorption
- A transient iron deficiency in infancy
- An autoimmune destruction of intrinsic factor
- A condition treated primarily with folic acid
Correct Answer: Genetic iron overload due to increased intestinal absorption
Q13. Which of the following is an erythropoiesis-stimulating agent used in anemia of chronic kidney disease?
- Epoetin alfa
- Deferasirox
- Ferrous gluconate
- Hydroxyurea
Correct Answer: Epoetin alfa
Q14. Folic acid deficiency typically results in which hematological picture?
- Megaloblastic anemia with hypersegmented neutrophils
- Microcytic hypochromic anemia
- Aplastic anemia with pancytopenia
- Sideroblastic anemia with ring sideroblasts
Correct Answer: Megaloblastic anemia with hypersegmented neutrophils
Q15. Pernicious anemia is caused by deficiency of which gastric factor?
- Intrinsic factor
- Gastrin
- Pepsin
- Secretin
Correct Answer: Intrinsic factor
Q16. A typical laboratory profile of iron deficiency anemia includes:
- Low ferritin, low serum iron, high TIBC, microcytic hypochromic RBCs
- High ferritin, high serum iron, low TIBC, macrocytic RBCs
- Normal ferritin, high serum iron, normal TIBC, normocytic RBCs
- Low ferritin, high serum iron, low TIBC, hemolysis
Correct Answer: Low ferritin, low serum iron, high TIBC, microcytic hypochromic RBCs
Q17. The most useful initial screening test for hereditary hemochromatosis is:
- Serum transferrin saturation
- Bone marrow iron stain
- Serum folate
- Peripheral smear for target cells
Correct Answer: Serum transferrin saturation
Q18. Which iron chelator is administered parenterally (IM or IV) rather than orally?
- Deferoxamine
- Deferasirox
- Deferiprone
- Cyanocobalamin
Correct Answer: Deferoxamine
Q19. Co-administration of oral iron with tetracycline antibiotics results in:
- Formation of non-absorbable complexes and reduced antibiotic absorption
- Enhanced efficacy of tetracycline due to iron synergy
- Rapid renal clearance of iron
- Increased bioavailability of both drugs
Correct Answer: Formation of non-absorbable complexes and reduced antibiotic absorption
Q20. To minimize GI side effects while still treating iron deficiency, one recommended approach is:
- Take oral iron with food (accepting reduced absorption)
- Double the dose and take on empty stomach
- Discontinue iron and use only vitamin C
- Switch to high-dose oral manganese
Correct Answer: Take oral iron with food (accepting reduced absorption)
Q21. Anemia of chronic disease typically shows which pattern?
- Low serum iron, low TIBC, normal or high ferritin
- High serum iron, high TIBC, low ferritin
- High serum iron, low TIBC, low ferritin
- Low serum iron, high TIBC, low ferritin
Correct Answer: Low serum iron, low TIBC, normal or high ferritin
Q22. Which hematinic is the drug of choice to treat vitamin B12 deficiency?
- Cyanocobalamin (vitamin B12)
- Folic acid
- Ferrous sulfate
- Deferiprone
Correct Answer: Cyanocobalamin (vitamin B12)
Q23. The primary site of dietary iron absorption in the gastrointestinal tract is:
- Duodenum and proximal jejunum
- Ileum
- Colon
- Stomach fundus
Correct Answer: Duodenum and proximal jejunum
Q24. Recommended prophylactic elemental iron dose during pregnancy is generally:
- 30–60 mg elemental iron daily
- 5–10 mg elemental iron daily
- 200–300 mg elemental iron daily
- Only parenteral iron is recommended in pregnancy
Correct Answer: 30–60 mg elemental iron daily
Q25. In iron deficiency anemia, total iron-binding capacity (TIBC) is usually:
- Increased
- Decreased
- Unchanged
- Irrelevant to diagnosis
Correct Answer: Increased
Q26. An immediate severe adverse reaction to IV iron that clinicians must watch for is:
- Anaphylaxis with hypotension
- Chronic kidney disease progression
- Delayed hemolysis after 2 weeks
- Hyperglycemia and polyuria
Correct Answer: Anaphylaxis with hypotension
Q27. Which parenteral iron preparation commonly requires a test dose because of hypersensitivity risk?
- Iron dextran
- Iron sucrose
- Ferric carboxymaltose
- Oral ferrous gluconate
Correct Answer: Iron dextran
Q28. Which oral iron chelator has been associated with agranulocytosis and requires blood count monitoring?
- Deferiprone
- Deferasirox
- Deferoxamine
- Ferrous fumarate
Correct Answer: Deferiprone
Q29. An advantage of ferric carboxymaltose over older IV irons is:
- Ability to give larger single doses with fewer infusions
- Higher risk of anaphylaxis requiring ICU monitoring
- It is an oral preparation only
- It chelates iron and increases urinary excretion
Correct Answer: Ability to give larger single doses with fewer infusions
Q30. The primary biochemical role of folic acid in hematopoiesis is:
- Participation in DNA synthesis (thymidylate production) for rapidly dividing cells
- Direct oxygen transport in hemoglobin
- Iron storage in ferritin
- Activation of erythropoietin receptors
Correct Answer: Participation in DNA synthesis (thymidylate production) for rapidly dividing cells
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