Anemia: types and pharmacotherapy MCQs With Answer

Introduction:
Anemia is a multifactorial clinical problem frequently encountered in pharmacotherapeutics. For M.Pharm students, understanding the types of anemia, their pathophysiology, diagnostic markers and targeted pharmacotherapy is essential for rational drug selection, dosing and monitoring. This quiz collection focuses on iron-deficiency, megaloblastic, hemolytic, aplastic, sideroblastic and anemia of chronic disease, and integrates pharmacologic interventions including oral and parenteral iron formulations, erythropoiesis-stimulating agents, vitamin B12 and folate therapy, chelators, and disease-specific agents. Each question tests mechanistic understanding, therapeutic indications, adverse effects and clinical decision-making relevant to postgraduate pharmacy practice.

Q1. Which laboratory pattern is most characteristic of iron deficiency anemia?

• Low serum ferritin, low MCV, high total iron-binding capacity (TIBC)
• High serum ferritin, high MCV, low TIBC
• Normal ferritin, high reticulocyte count, high LDH
• Low ferritin, low RBC count, decreased TIBC

Correct Answer: Low serum ferritin, low MCV, high total iron-binding capacity (TIBC)

Q2. The first-line oral iron preparation commonly used for uncomplicated iron deficiency anemia is:

• Ferrous sulfate
• Ferric carboxymaltose
• Deferoxamine
• Iron dextran

Correct Answer: Ferrous sulfate

Q3. Which adverse effect is most commonly associated with oral ferrous sulfate therapy?

• Gastrointestinal irritation and constipation
• Nephrotoxicity
• Cardiac arrhythmias
• Pulmonary fibrosis

Correct Answer: Gastrointestinal irritation and constipation

Q4. A patient with chronic kidney disease and symptomatic anemia refractory to oral iron is best managed with which agent?

• Erythropoiesis-stimulating agent such as epoetin alfa
• Pyridoxine (vitamin B6)
• Hydroxyurea
• Deferasirox

Correct Answer: Erythropoiesis-stimulating agent such as epoetin alfa

Q5. Which intravenous iron formulation carries the highest risk of anaphylactic reactions historically and thus requires test dosing?

• Iron dextran
• Ferric carboxymaltose
• Iron sucrose
• Ferumoxytol

Correct Answer: Iron dextran

Q6. In megaloblastic anemia due to vitamin B12 deficiency, which treatment should be avoided until deficiency is corrected?

• Giving folic acid alone without vitamin B12
• Parenteral hydroxocobalamin
• Oral vitamin B12 replacement
• Monitoring methylmalonic acid levels

Correct Answer: Giving folic acid alone without vitamin B12

Q7. A 25-year-old male with hemolysis after taking a single dose of primaquine most likely has which enzymatic deficiency?

• G6PD deficiency
• Pyruvate kinase deficiency
• Sphingomyelinase deficiency
• Glutathione synthetase deficiency

Correct Answer: G6PD deficiency

Q8. Which pharmacologic agent is the cornerstone of therapy for sideroblastic anemia due to isoniazid therapy?

• Pyridoxine (vitamin B6)
• Deferiprone
• Hydroxyurea
• Folic acid

Correct Answer: Pyridoxine (vitamin B6)

Q9. Which statement about erythropoiesis-stimulating agents (ESAs) is correct?

• ESAs increase hemoglobin but may increase risk of thromboembolic events and stroke when targeting high Hb levels
• ESAs are contraindicated in all cancer patients with anemia
• ESAs act by increasing iron absorption from the gut
• ESAs cause immediate reticulocyte rise within 1 hour of administration

Correct Answer: ESAs increase hemoglobin but may increase risk of thromboembolic events and stroke when targeting high Hb levels

Q10. The most appropriate initial management for acute severe symptomatic blood loss anemia is:

• Transfusion of packed red blood cells
• Oral ferrous sulfate therapy
• Deferasirox chelation
• Pyridoxine supplementation

Correct Answer: Transfusion of packed red blood cells

Q11. Which chelating agent is administered intravenously or subcutaneously and commonly used for acute iron overload?

• Deferoxamine
• Deferiprone
• Deferasirox
• EDTA

Correct Answer: Deferoxamine

Q12. In transfusion-dependent beta-thalassemia major, chronic iron overload is best monitored by measuring:

• Serum ferritin and cardiac/liver MRI for iron quantification
• Complete blood count alone
• Serum vitamin B12 levels
• Platelet function tests

Correct Answer: Serum ferritin and cardiac/liver MRI for iron quantification

Q13. Which drug is used to reduce painful vaso-occlusive crises and multiplex hemolytic complications in sickle cell disease?

• Hydroxyurea
• Deferasirox
• Epoetin beta
• Iron sucrose

Correct Answer: Hydroxyurea

Q14. An older adult with unexplained normocytic anemia of chronic disease due to inflammation is likely to benefit from which pharmacologic approach?

• Treat underlying inflammation and consider intravenous iron or ESA if indicated
• High-dose oral iron irrespective of ferritin
• Immediate splenectomy
• Long-term deferiprone therapy

Correct Answer: Treat underlying inflammation and consider intravenous iron or ESA if indicated

Q15. Which medication can precipitate aplastic anemia and should be recognized as a potential cause of drug-induced bone marrow failure?

• Chloramphenicol
• Ferrous fumarate
• Pyridoxine
• Folic acid

Correct Answer: Chloramphenicol

Q16. Which feature distinguishes hemolytic anemia from iron-deficiency anemia on laboratory testing?

• Elevated LDH and indirect bilirubin with increased reticulocyte count in hemolysis
• Low TIBC in hemolysis
• Low reticulocyte count in hemolysis
• Low serum ferritin in hemolysis

Correct Answer: Elevated LDH and indirect bilirubin with increased reticulocyte count in hemolysis

Q17. For a patient with pernicious anemia due to intrinsic factor deficiency, the preferred route of vitamin B12 replacement is:

• Parenteral (intramuscular or subcutaneous) vitamin B12
• High-dose oral ferrous sulfate
• Topical folinic acid
• Oral pyridoxine only

Correct Answer: Parenteral (intramuscular or subcutaneous) vitamin B12

Q18. Which drug used in thalassemia major binds excess intracellular iron and is orally active?

• Deferasirox
• Deferoxamine
• Deferoxamine mesylate (IV only)
• Deferiprone (not orally active)

Correct Answer: Deferasirox

Q19. Roxadustat and other HIF prolyl hydroxylase inhibitors treat anemia primarily by:

• Stabilizing HIF to increase endogenous erythropoietin and improve iron metabolism
• Chelating iron to reduce iron stores
• Directly stimulating RBC release from spleen
• Antagonizing hepcidin receptor to block iron absorption

Correct Answer: Stabilizing HIF to increase endogenous erythropoietin and improve iron metabolism

Q20. Which medication commonly used for autoimmune hemolytic anemia acts by B-cell depletion and is used when steroids fail?

• Rituximab
• Captopril
• Furosemide
• Deferiprone

Correct Answer: Rituximab

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