Drug-induced hematological disorders: detection and management MCQs With Answer

Drug-induced hematological disorders: detection and management MCQs With Answer

This quiz set is designed for M.Pharm students to deepen understanding of drug-induced hematological disorders—covering mechanisms, common offending agents, diagnostic strategies, laboratory interpretation and rational management. Questions emphasise real-world clinical reasoning: recognizing laboratory patterns (e.g., haemolysis vs marrow suppression), applying specific tests (direct Coombs, reticulocyte count, peripheral smear, bone marrow examination), scoring tools (4T for HIT) and selecting appropriate therapeutic responses (drug withdrawal, steroids, IVIG, G-CSF, alternative anticoagulation). The material links pharmacologic mechanisms to clinical presentations and treatment choices to prepare pharmacists for safe medication use, monitoring and counselling in patients at risk of hematologic adverse effects.

Q1. Which laboratory finding most strongly suggests immune-mediated hemolytic anemia due to a drug?

• Low reticulocyte count with pancytopenia
• Positive direct antiglobulin (Coombs) test with spherocytes on peripheral smear
• High haptoglobin with normocytic indices
• Bone marrow hypocellularity without hemolysis markers

Correct Answer: Positive direct antiglobulin (Coombs) test with spherocytes on peripheral smear

Q2. A patient receiving chloramphenicol develops severe pancytopenia. Which mechanism best explains this adverse effect?

• Immune complex-mediated peripheral destruction of platelets
• Idiosyncratic, dose-independent aplastic anemia due to bone marrow stem cell toxicity
• Oxidative hemolysis due to G6PD inhibition
• Complement activation causing intravascular hemolysis

Correct Answer: Idiosyncratic, dose-independent aplastic anemia due to bone marrow stem cell toxicity

Q3. Which drug is most commonly associated with agranulocytosis requiring regular blood monitoring?

• Ciprofloxacin
• Clozapine
• Metformin
• Hydrochlorothiazide

Correct Answer: Clozapine

Q4. In suspected heparin-induced thrombocytopenia (HIT), which immediate management step is appropriate once HIT is likely?

• Continue heparin and start platelet transfusion
• Stop all heparin products and start a non-heparin anticoagulant (e.g., argatroban)
• Give vitamin K and wait for platelet recovery
• Start high-dose aspirin and observe

Correct Answer: Stop all heparin products and start a non-heparin anticoagulant (e.g., argatroban)

Q5. Which laboratory pattern is characteristic of intravascular hemolysis caused by a drug?

• Low LDH, high haptoglobin, low indirect bilirubin
• High LDH, low haptoglobin, elevated indirect bilirubin and hemoglobinuria
• High reticulocyte count with normal bilirubin and haptoglobin
• Pancytopenia with low reticulocyte count

Correct Answer: High LDH, low haptoglobin, elevated indirect bilirubin and hemoglobinuria

Q6. A patient on dapsone develops sudden acute hemolysis. Which predisposing condition should be suspected?

• Folate deficiency
• G6PD deficiency
• Vitamin B12 deficiency
• Iron overload

Correct Answer: G6PD deficiency

Q7. Linezolid is associated with which reversible hematological toxicity after prolonged use?

• Heparin-induced thrombocytopenia
• Bone marrow suppression causing thrombocytopenia and anemia
• Immune hemolytic anemia with positive Coombs
• Macrocytosis due to folate deficiency

Correct Answer: Bone marrow suppression causing thrombocytopenia and anemia

Q8. For drug-induced immune thrombocytopenia presenting with severe bleeding, which is the best initial therapy?

• Immediate platelet transfusion only
• High-dose corticosteroids ± IVIG and stop the offending drug
• Continue the drug and observe platelet counts
• Oral tranexamic acid alone

Correct Answer: High-dose corticosteroids ± IVIG and stop the offending drug

Q9. A patient on methimazole develops agranulocytosis. Which sign should prompt urgent WBC testing?

• Mild fatigue without fever
• Fever and sore throat
• Nausea alone
• Rash limited to a small area

Correct Answer: Fever and sore throat

Q10. Which test helps distinguish hemolysis due to immune causes from non-immune causes?

• Serum ferritin
• Direct antiglobulin (Coombs) test
• Bone marrow biopsy
• Prothrombin time

Correct Answer: Direct antiglobulin (Coombs) test

Q11. Which chemotherapeutic agent is classically associated with dose-dependent bone marrow suppression leading to pancytopenia?

• Vincristine
• Cisplatin
• Carboplatin
• Fluorouracil (5-FU)

Correct Answer: Fluorouracil (5-FU)

Q12. A patient on trimethoprim-sulfamethoxazole presents with pancytopenia and hypersegmented neutrophils. Which mechanism is most likely?

• Folate antagonism causing megaloblastic marrow suppression
• Type II hypersensitivity causing platelet destruction
• Oxidative hemolysis due to G6PD deficiency
• Complement-mediated intravascular hemolysis

Correct Answer: Folate antagonism causing megaloblastic marrow suppression

Q13. Which peripheral smear finding is most suggestive of microangiopathic hemolytic anemia from a drug-related TMA?

• Target cells
• Schistocytes (fragmented RBCs)
• Macro-ovalocytes
• Howell-Jolly bodies

Correct Answer: Schistocytes (fragmented RBCs)

Q14. A patient on heparin develops a platelet drop on day 10 and new thrombosis. Which diagnostic assay confirms HIT by detecting pathogenic antibodies?

• Bone marrow biopsy
• Serotonin release assay (functional platelet activation test)
• Serum ferritin level
• Direct Coombs test

Correct Answer: Serotonin release assay (functional platelet activation test)

Q15. Which management strategy is appropriate for severe drug-induced aplastic anemia?

• Immediate corticosteroids alone
• Withdrawal of offending drug, supportive transfusions, consider bone marrow transplant or immunosuppressive therapy
• High-dose anticoagulation
• Only oral iron supplementation

Correct Answer: Withdrawal of offending drug, supportive transfusions, consider bone marrow transplant or immunosuppressive therapy

Q16. Which drug is commonly implicated in immune thrombocytopenia via hapten formation on platelet glycoproteins?

• Quinine/quinidine
• Metoprolol
• Acetaminophen
• Omeprazole

Correct Answer: Quinine/quinidine

Q17. What is the expected reticulocyte response in hemolysis due to a drug versus aplastic anemia from a drug?

• Hemolysis: low reticulocyte; Aplastic: high reticulocyte
• Hemolysis: high reticulocyte; Aplastic: low reticulocyte
• Both show high reticulocyte counts
• Neither shows any change in reticulocyte count

Correct Answer: Hemolysis: high reticulocyte; Aplastic: low reticulocyte

Q18. Which therapy is appropriate for severe immune-mediated thrombocytopenia refractory to steroids?

• Start heparin
• Rituximab or splenectomy and/or IVIG
• High-dose vitamin C
• Begin iron chelation therapy

Correct Answer: Rituximab or splenectomy and/or IVIG

Q19. Which drug is classically associated with aplastic anemia by unpredictable idiosyncratic reaction rather than cumulative dose effect?

• Azathioprine
• Chloramphenicol
• Furosemide
• Vitamin B12

Correct Answer: Chloramphenicol

Q20. When counselling a patient starting dapsone, which baseline test is most important to minimize risk of hemolytic crisis?

• Serum creatinine
• G6PD assay
• Thyroid function tests
• Hepatitis panel only

Correct Answer: G6PD assay

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