Hematology - Immuno Case Questions - Dr. Malagueño

Hematology Module Exam – Ratio
Year Level II
1. The following are characteristics of Hypoproliferative anemias except;

a. Normocytic
b. Normochromic
c. Inappropriately High Reticulocyte response
d. None of the above
Answer: C. Inappropriately High Reticulocyte response.

Hypoproliferative anemias are characterized by normocytic, normochromic red cells and
inappropriately low reticulocyte index.
2. The following are examples of hypoproliferative anemia, except

a. Anemia of inflammation
b. Anemia of renal disease
c. iron deficiency anemia
d. Anemia from marrow damage
e. Sideroblastic anemia
Answer: Sideroblastic anemia
3. What is the lifespan of RBCs

a. 90 days b. 4 months C. 200 days D. 2 months
Sample Case: A 24 /F presents with pallor, and occasional exertional dyspnea. She reports
having heavy menstrual bleeding and dysmenorrhea. No known co-morbids. No family
history of blood disorders. CBC done showed hemoglobin of 9.0 g/dL, Hematocrit of 28%, RBC
of 2.5 x 10 12 /L, MCV of 57 fL, MCH 26 pg, RDW of 16%, WBC 5 x 109/L, platelet count of 500 x
109/L
4. What is the most likely diagnosis?
a. Microcytic, hypochromic anemia
b. Macrocytic, Hypochromic
c. Microcytic, Hyperchromic
d. None of the above
5. Referring to the case above, what is the most likely cause of anemia?
a. Inflammation
b. Hemolysis
c. Iron Deficiency
d. Folate Deficiency
e. Bone Marrow Depression
6. Based on the case above, what is the best initial therapy?
a. Erythropoeitin administration
b. Folic acid supplementation
c. Oral Iron Supplementation
d. Blood Transfusion
e. Bone marrow Transplantation
7. Which of the following is NOT part of the important differentials for microcytic
hypochromic anemia?
a. Thalassemia
b. Prolonged Anemia of chronic disease
c. Iron Deficiency Anemia
d. Lead Poisoning
e. All of the above are part of the differentials
ANSWER: Important Differentials for microcytic, hypochromic anemia- TAILS

Thalassemia
Anemia of Chronic Disease (if Prolonged)
Iron Deficiency Anemia
Lead poisoning
Sideroblastic Anemia
8. Which the following is the correct definition of anemia according to WHO?

a. Hemoglobin <14 g/dL in men, <12 g/dL in women
b. Hemoglobin <13 g/dL in men, <12 g/dL in women
c. Hemoglobin <12 g/dL in men, <13 g/dL in women
d. Hemoglobin <12 g/dL in men, <14g/dL in women
9. Which of the following statements about iron metabolism is incorrect?

a. Ferric Iron form in the gut is converted to Ferrous form by ferrireductase
b. Ferrous Iron form once released at the basolateral membrane of the gut cell via
ferroportin is oxidized to ferric form by hephaestin
c. Transferrin carries the ferrous iron form
d. Hepcidin regulates the serum iron level by downregulating the ferroportin
ANSWER RATIO: Transferrin carries the ferric iron form
10. What value of Serum ferritin (ug/L) indicates depleted Marrow iron stores?
a. <10 b. <15 c. <20 d. <25
11. As a cardinal rule, iron deficiency in an adult male or postmenopausal female is due to
__________________ until proven otherwise.
a. Cancer in origin
b. GI Bleeding
c. Inadequate dietary Intake
d. Leukemia
e. Malabsorption
12. Which of the following normal values is abnormal ?

a. TIBC – 300-360 ug/dL
b. Serum Iron – 50-150 ug/dL
c. Transferrin Saturation – 25-50%
d. MCV – 100-180 fL
Ratio: Normal MCV – 80-100 fL
13. Mentzer index is calculated as MCV (fL)/RBC count (million/uL). If the result is >13,
what is the most likely cause of anemia?
a. Thalassemia b. IDA c. Sideroblastic d. Inflammation d. Chronic kidney
disease
14. Transfusion of 1 unit Packed RBC increases Hemoglobin by how much?

a. 0.5 g/dL b. 1 g/dL c. 1.5 g/dL d. 2 g/dL e. 2.5 g/dL
15. Hemoglobin transports O2 from lungs to tissues and carbon dioxide (CO2) from
tissues to lungs and is a nitrate reductase that releases nitric oxide (NO) from nitrite
to promote vasodilation. Oxygen binding is defined by the sigmoidal shape of the
hemoglobin-O2 dissociation curve. If there is shift to the right in the Oxygen-
hemoglobin dissociation curve, it indicates which of the following?
A. Hemoglobin has high O2 affinity, decreasing O2 delivery to tissues
B. Hemoglobin has low O2 affinity, releasing more O2 to tissues.
C. Hemoglobin has high O2 affinity, releasing more O2 to tissues
D. Hemoglobin has low O2 affinity, decreasing O2 delivery to tissues
16. What is the most important modulator of O2 affinity?

a. Temperature
b. pH
c. 2,3 BPG
d. CO2 level
Fill in the blanks with the letter of the correct answer.

a. Increase
b. Decrease
c. Normal
TESTS IRON INFLAMMATION THALASSEMIA SIDEROBLASTIC
DEFICIENCY ANEMIA
Serum Decrease 19. ____ Normal to Normal to high
Iron high
TIBC 17.____ decrease 20. ______ Normal
Percent decrease decrease 30-80 % 30-80 %
Saturation
Ferritin 18._____ Increase high 21. ______
ANSWER FOR ITEMS 17-21.

17. A
18. B
19. B
20. C
21. A

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Hematology Module Exam – Ratio

1. The following are characteristics of Hypoproliferative anemias except;

Answer: C. Inappropriately High Reticulocyte response.

2. The following are examples of hypoproliferative anemia, except

Answer: Sideroblastic anemia

3. What is the lifespan of RBCs

ANSWER: Important Differentials for microcytic, hypochromic anemia- TAILS

8. Which the following is the correct definition of anemia according to WHO?

9. Which of the following statements about iron metabolism is incorrect?

ANSWER RATIO: Transferrin carries the ferric iron form

12. Which of the following normal values is abnormal ?

Ratio: Normal MCV – 80-100 fL

14. Transfusion of 1 unit Packed RBC increases Hemoglobin by how much?

16. What is the most important modulator of O2 affinity?

Fill in the blanks with the letter of the correct answer.

ANSWER FOR ITEMS 17-21.

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