Anemia is a common hematology topic for B. Pharm students, covering reduced hemoglobin or red blood cell mass, impaired oxygen delivery, and varied clinical presentations. This introduction reviews anemia and its types—iron‑deficiency, megaloblastic (vitamin B12/folate), hemolytic, aplastic, sideroblastic, and anemia of chronic disease—plus pathophysiology, diagnostic markers (CBC, MCV, MCHC, RDW, ferritin, transferrin saturation, reticulocyte count), and pharmacological management including oral and IV iron, vitamin replacement, erythropoiesis‑stimulating agents, and chelation. Emphasis is placed on drug mechanisms, dosing, monitoring, interactions, and adverse effects relevant to pharmacy practice. Expect emphasis on drug choice, interactions, monitoring, and patient counseling. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which MCV value typically indicates microcytic anemia?
- MCV <80 fL
- MCV 80–100 fL
- MCV >100 fL
- MCV 100–120 fL
Correct Answer: MCV <80 fL
Q2. The most common cause of anemia worldwide is:
- Iron deficiency due to nutritional deficiency or chronic blood loss
- Vitamin B12 deficiency
- Hemolytic anemia from autoimmune causes
- Aplastic anemia
Correct Answer: Iron deficiency due to nutritional deficiency or chronic blood loss
Q3. Which laboratory finding is most specific for iron deficiency anemia?
- High ferritin
- Low ferritin
- High transferrin saturation
- Elevated MCV
Correct Answer: Low ferritin
Q4. Approximately how much elemental iron is present in ferrous sulfate 325 mg?
- 65 mg elemental iron
- 100 mg elemental iron
- 35 mg elemental iron
- 10 mg elemental iron
Correct Answer: 65 mg elemental iron
Q5. Which coadministered substance enhances absorption of oral ferrous iron?
- Vitamin C (ascorbic acid)
- Calcium carbonate
- Proton pump inhibitors
- Tetracycline antibiotics
Correct Answer: Vitamin C (ascorbic acid)
Q6. Which intravenous iron formulation historically carried the highest risk of anaphylactic reactions?
- High‑molecular‑weight iron dextran
- Ferric carboxymaltose
- Iron sucrose
- Ferumoxytol
Correct Answer: High‑molecular‑weight iron dextran
Q7. Which clinical feature helps distinguish vitamin B12 deficiency from folate deficiency?
- Peripheral neuropathy with paresthesia and gait disturbance
- Glossitis only
- Isolated hypersegmented neutrophils without neurologic signs
- Purely low MCV without neurologic changes
Correct Answer: Peripheral neuropathy with paresthesia and gait disturbance
Q8. Pernicious anemia is most directly associated with which diagnostic finding?
- Positive anti‑intrinsic factor antibodies
- Low serum folate only
- High serum ferritin
- Elevated reticulocyte count
Correct Answer: Positive anti‑intrinsic factor antibodies
Q9. A markedly increased reticulocyte count most likely indicates which process?
- Active hemolysis or brisk marrow response
- Iron‑deficiency with marrow failure
- Megaloblastic failure to produce reticulocytes
- Aplastic anemia with low reticulocytes
Correct Answer: Active hemolysis or brisk marrow response
Q10. A positive direct antiglobulin (direct Coombs) test indicates which condition?
- Autoimmune hemolysis due to antibodies on RBCs
- Iron deficiency anemia
- Thalassemia trait
- Aplastic anemia
Correct Answer: Autoimmune hemolysis due to antibodies on RBCs
Q11. Which antimalarial drug is classically associated with hemolysis in G6PD deficiency?
- Primaquine
- Allopurinol
- Metronidazole
- Propranolol
Correct Answer: Primaquine
Q12. Presence of target cells on peripheral smear most strongly suggests which condition?
- Thalassemia trait
- Iron deficiency anemia
- Megaloblastic anemia
- Aplastic anemia
Correct Answer: Thalassemia trait
Q13. An increased red cell distribution width (RDW) is most characteristic of which anemia?
- Iron‑deficiency anemia
- Thalassemia trait
- Sickle cell anemia
- Aplastic anemia
Correct Answer: Iron‑deficiency anemia
Q14. Which pattern of iron studies is characteristic of anemia of chronic disease?
- Low serum iron, low TIBC, normal or high ferritin
- Low serum iron, high TIBC, low ferritin
- High serum iron, low ferritin, high TIBC
- Low serum iron, normal TIBC, low ferritin
Correct Answer: Low serum iron, low TIBC, normal or high ferritin
Q15. Erythropoiesis‑stimulating agents (ESAs) are primarily indicated for anemia associated with:
- Chronic kidney disease
- Acute iron deficiency from bleeding
- Vitamin B12 deficiency
- Autoimmune hemolysis
Correct Answer: Chronic kidney disease
Q16. A major safety concern when using ESAs is:
- Increased risk of thrombotic events and hypertension
- Severe neutropenia
- Ototoxicity
- Marked hypoglycemia
Correct Answer: Increased risk of thrombotic events and hypertension
Q17. Recommended daily elemental iron replacement for treating iron deficiency in adults is approximately:
- 100–200 mg elemental iron per day
- 10 mg elemental iron per day
- 500 mg elemental iron per day
- 1,000 mg elemental iron per day
Correct Answer: 100–200 mg elemental iron per day
Q18. The hallmark bone marrow finding in sideroblastic anemia is:
- Ring sideroblasts with iron‑loaded mitochondria around the nucleus
- Target cells predominantly
- Hypersegmented neutrophils
- Hypocellular marrow without iron
Correct Answer: Ring sideroblasts with iron‑loaded mitochondria around the nucleus
Q19. For chronic transfusional iron overload requiring oral chelation, which agent is commonly used?
- Deferasirox (oral iron chelator)
- Deferoxamine (parenteral chelator only)
- Vitamin C monotherapy
- Phlebotomy as first‑line in transfusion‑dependent patients
Correct Answer: Deferasirox (oral iron chelator)
Q20. According to WHO, the hemoglobin cutoff defining anemia in non‑pregnant women is:
- <12 g/dL
- <13 g/dL
- <11 g/dL
- <10 g/dL
Correct Answer: <12 g/dL
Q21. In hemodynamically stable adult patients, a commonly used transfusion trigger for packed RBCs is an Hb of:
- <7 g/dL
- <10 g/dL
- <9 g/dL
- <11 g/dL
Correct Answer: <7 g/dL
Q22. Which laboratory pattern is typical of acute intravascular hemolysis?
- Decreased haptoglobin and increased indirect bilirubin
- Increased haptoglobin and decreased bilirubin
- Low LDH and low bilirubin
- Decreased reticulocyte count only
Correct Answer: Decreased haptoglobin and increased indirect bilirubin
Q23. The antidote for methotrexate‑induced folate pathway toxicity is:
- Folinic acid (leucovorin)
- Folic acid only
- Vitamin B12
- Pyridoxine (vitamin B6)
Correct Answer: Folinic acid (leucovorin)
Q24. Splenectomy is a therapeutic option for which hemolytic condition?
- Hereditary spherocytosis
- Iron deficiency anemia
- Thalassemia minor
- Megaloblastic anemia due to folate deficiency
Correct Answer: Hereditary spherocytosis
Q25. Which statement about ferritin is correct?
- Ferritin is an acute‑phase reactant and may be elevated in inflammation
- Ferritin is always low only in iron deficiency without exception
- Ferritin directly measures circulating transferrin‑bound iron
- Ferritin is not useful in evaluating iron stores
Correct Answer: Ferritin is an acute‑phase reactant and may be elevated in inflammation
Q26. Which monitoring is essential in patients receiving deferasirox therapy?
- Periodic renal and hepatic function tests
- Routine ECG only
- Daily complete blood count only
- Fasting blood glucose monitoring only
Correct Answer: Periodic renal and hepatic function tests
Q27. An elevated hemoglobin A2 (HbA2) on electrophoresis suggests which diagnosis?
- Beta‑thalassemia trait
- Alpha‑thalassemia trait
- Iron deficiency anemia
- Sideroblastic anemia
Correct Answer: Beta‑thalassemia trait
Q28. Which vitamin deficiency classically produces hypersegmented neutrophils on peripheral smear?
- Vitamin B12 deficiency
- Iron deficiency
- Vitamin C deficiency
- Pyridoxine (vitamin B6) deficiency
Correct Answer: Vitamin B12 deficiency
Q29. A classic peripheral smear finding in lead poisoning is:
- Basophilic stippling of red blood cells
- Howell‑Jolly bodies
- Target cells
- Spherocytes
Correct Answer: Basophilic stippling of red blood cells
Q30. First‑line therapy for pernicious anemia to correct B12 deficiency is:
- Intramuscular vitamin B12 (cyanocobalamin) injections
- Oral folic acid supplements
- Oral iron therapy
- Intravenous iron infusion
Correct Answer: Intramuscular vitamin B12 (cyanocobalamin) injections
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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