Hematology II

1. ABO blood group system was discovered by Karl Landsteiner in---------

A. 1900
B. 1901
C. 1902
D. 1903
2. What antibodies are found in the plasma of someone with blood type A;
A. Anti-B antibodies
B. Anti-A antibodies
C. Both Anti-A and Anti-B antibodies
D. None
3. What antibodies are found in the plasma of someone with blood type B;
A. Anti-B antibodies
B. Anti-A antibodies
C. Both Anti-A and Anti-B antibodies
D. None
4. What antibodies are found in the plasma of someone with blood type AB;
A. Anti-B antibodies
B. Anti-A antibodies
C. Both Anti-A and Anti-B antibodies
D. None
5. What antibodies are found in the plasma of someone with blood type O;
A. Anti-B antibodies
B. Anti-A antibodies
C. Both Anti-A and Anti-B antibodies
D. None
6. If a person has blood type A, which antigen is present on their red blood cells
A. Antigen A
B. Antigen B
C. Both antigen A and antigen B
D. None
7. If a person has blood type B, which antigen is present on their red blood cells
A. Antigen A
B. Antigen B
C. Both antigen A and antigen B
D. None
8. If a person has blood type AB, which antigen is present on their red blood cells
A. Antigen A
B. Antigen B
C. Both antigen A and antigen B
D. None
9. If a person has blood type 0, which antigen is present on their red blood cells;
A. Antigen A
 B. Antigen B
C. Both antigen A and antigen B
D. None
10. In the ABO blood group system, which genotype combinations result in blood type A;
A. AA or AO
B. BB or BO
C. AB
D. OO
11. In the ABO blood group system, which genotype combinations result in blood type B;
A. AA or AO
B. BB or BO
C. AB
D. OO
12. In the ABO blood group system, which genotype combinations result in blood type AB;
A. AA or AO
B. BB or BO
C. AB
D. OO
13. In the ABO blood group system, which genotype combinations result in blood type 0;
A. AA or AO
B. BB or BO
C. AB
D. OO
14. Which blood group in the ABO system has no antigens on the red blood cells;
A. A
B. B
C. AB
D. O
15. Which blood group in the ABO system has no antibodies on the red blood cells;
A. A
B. AB
C. B
D. O
16. Which antibody isotype is primarily responsible for ABO blood type reactions;
A. IgG
B. IgE
C. IgA
D. IgM
17. Which component of the blood is primarily used to determine ABO blood groups;
A. White blood cells
B. Red blood cells
C. Plasma
D. Platelets
18. The ABO blood grouping system is based on which of the following principles
 A. The presence of proteins on white blood cells
B. The presence of specific antigens on red blood cells
C. Differences in platelet size
D. Variations in plasma composition
19. The principle of agglutination in blood grouping is;
A. Mixing blood samples without reaction
B. Clumping of red blood cells in the presence of specific antibodies
C. Dissolving red blood cells to release oxygen
D. Separating blood into plasma and cells
20. The gene responsible for the ABO blood group is located on which chromosome?
A. Chromosome 1
B. Chromosome 11
C. Chromosome 9
D. Chromosome 10
21. The products of the A and B genes are enzymes that act as a specific;
A. Transaminases
B. Transferases
C. Amylases
D. Glucosidases
22. The primary structural difference between an RBC precursor with the A blood group and one with
the B blood group is;
A. Different hemoglobin molecules
B. Different glycosyltransferase enzymes
C. Different nucleus structure
D. Absence of the H antigen
23. In blood group biochemistry, glycosyltransferases are enzymes that;
A. Transport oxygen in RBC precursors
B. Add specific sugars to produce A or B antigens
C. Stabilize the RBC nucleus
D. Break down hemoglobin
24. The H antigen is synthesized by the activity of which enzyme;
A. A transferase
B. B transferase
C. H transferase (fucosyltransferase)
D. Rh transferase
25. The H antigen precursor in the ABO blood group system is formed by the addition of which sugar
molecule;
A. Galactose
B. N-acetylgalactosamine
C. Fucose
D. Glucose
26. The gene responsible for coding the enzyme that synthesizes the H antigen is;
A. ABO gene
B. FUT1 gene
 C. RH gene
D. SLC4A1 gene
27. Which chromosome houses the FUT1 gene, responsible for the synthesis of the H antigen;
A. Chromosome 9
B. Chromosome 19
C. Chromosome 1
D. Chromosome 7
28. The presence of the H antigen is required for the formation of which ABO blood group antigen;
A. Only A antigen
B. Only B antigen
C. Both A and B antigens
D. Neither A nor B antigen
29. The A antigen in the ABO blood group system is formed by the addition of which sugar molecule to
the H antigen?
A. Galactose
B. N-acetylgalactosamine
C. Fucose
D. Glucose
30. The B antigen in the ABO blood group system is created by adding which sugar to the H antigen?
A. Galactose
B. N-acetylgalactosamine
C. Fucose
D. Glucose
31. The enzymes responsible for converting the H antigen into A and B antigens are known as;
A. Fucosyltransferases
B. Glycosyltransferases
C. Lipid transferases
D. Nucleotidyltransferases
32. The gene for blood type A encodes an enzyme that adds which molecule to the H antigen;
A. Galactose
B. N-acetylgalactosamine
C. Fucose
D. Glucose
33. Individuals with blood type AB express both A and B antigens because;
A. They have two copies of the ABO gene.
B. They inherit alleles for both A and B enzymes.
C. They lack the H antigen
D. They have additional FUT1 genes.
34. In the ABO system, the presence of only the H antigen without additional modifications results in
which blood type;
A. Type A
B. Type B
C. Type O
D. Type AB
35. Which allele combination in the FUT1 gene would result in the lack of H antigen expression on red
blood cells;
A. HH
B. Hh
C. hh
D. Both HH and hh
36. The Bombay phenotype is characterized by the absence of which antigen on red blood cells;
A. A antigen
B. B antigen
C. H antigen
D. O antigen
37. The genetic basis of the Bombay phenotype is a mutation in which gene?
A. ABO gene
B. FUT1 gene
C. FUT2 gene
D. HLA gene
38. The Bombay phenotype is most commonly found in which population;
A. European
B. African
C. Indian
D. Native American
39. The Bombay phenotype was first discovered in which city?
A. Delhi
B. Mumbai
C. Kolkata
D. Chennai
40. A person with the Bombay phenotype can safely receive blood from which blood group donors
A. A
B. B
C. O
D. Only other Bombay phenotype individual
41. The Bombay phenotype is also known by which other term;
A. H-deficient phenotype
B. A/B/O blood group deficiency
C. Rare blood group
D. Rh-null phenotype
42. Which of the following statements is true about ABO antibodies in newborns;
A. They are present from birth
B. They develop immediately after birth
C. They are usually absent until 3-6 months of age
D. Newborns have high levels of ABO antibodies
43. ABO antibodies typically react best at which temperature;
A. 4°C
B. 22°C
 C. 37°C
D. Room temperature (20-25°C)
44. When does the production of ABO antibodies typically begin in humans;
A. Before birth
B. Immediately after birth
C. At 3-6 months of age
D. Around 1 year of age
45. Anti-A and anti-B antibodies in the ABO system are usually which type of immunoglobulin;
A. IgA
B. IgM
C. IgG
D. IgD
46. Which of the following methods is commonly used for ABO blood typing;
A. Enzyme-linked immunosorbent assay (ELISA)
B. Agglutination
C. Flow cytometry
D. Polymerase chain reaction (PCR)
47. Which type of antisera is used in forward ABO grouping to detect antigens on red blood cells;
A. Anti-IgG and Anti-IgM
B. Anti-D
C. Anti-A and Anti-B
D. Anti-H
48. In reverse ABO grouping, which of the following is detected?
A. ABO antigens on red blood cells
B. Antibodies in the patient’s plasma
C. Rh antigen on red blood cells
D. Blood cell morphology
49. Which result would indicate a blood type of AB in forward grouping;
A. Agglutination with anti-A but not with anti-B
B. Agglutination with anti-B but not with anti-A
C. Agglutination with both anti-A and anti-B
D. No agglutination with either anti-A or anti-B
50. In ABO testing, agglutination with anti-B serum and no agglutination with anti-A serum indicates
which blood type?
A. Type A
B. Type B
C. Type AB
D. Type O
51. Which of the following reagents is commonly used to perform reverse grouping in ABO testing;
A. Anti-A and Anti-B
B. A and B cell suspensions
C. Anti D
D. Rh control
52. Which of the following would indicate a discrepancy between forward and reverse grouping in ABO
testing
A. Agglutination in both forward and reverse grouping
B. No agglutination in forward grouping but agglutination in reverse grouping
C. Matching results between forward and reverse grouping
D. Presence of weak agglutination in reverse grouping
53. Which of the following ABO blood types will not show any agglutination with either anti-A or anti-B
in forward grouping;
A. Type A
B. Type B
C. Type AB
D. Type O
54. Which type of antibodies are routinely tested for in the reverse grouping process of ABO blood
typing;
A. Anti-H
B. Anti D
C. Naturally occurring ABO antibodies (IgM)
D. IgG antibodies
55. If forward grouping shows agglutination with anti-A but not with anti-B, while reverse grouping
shows agglutination with B cells, the blood type is
A. Type A
B. Type B
C. Type AB
D. Type O
56. Who are credited with the discovery of the Rh blood group system in 1939;
A. Alexander Wiener and Karl Landsteiner
B. Charles Drew and James Blundell
C. Karl Landsteiner and James Blundell
D. Louis Pasteur and Alexander Wiener
57. Which antibody is involved in the immune response to the Rh antigen in Rh-negative individuals?
A. IgA
B. IgM
C. IgG
D. IgE
58. Which of the following is a potential complication for an Rh-negative mother with an Rh-positive
fetus;
A. Hemolytic disease of the newborn (HDN)
B. Increased blood pressure
C. Gestational diabetes
D. Respiratory distress
59. In the Rh blood group system, which antigen is most commonly involved in Rh incompatibility
reactions;
A. A antigen
B. B antigen
 C. D antigen
D. O antigen
60. Which gene primarily determines the presence of the Rh(D) antigen on red blood cells?
A. RHD
B. RHCE
C. ABO
D. HBB
61. The RHCE gene is responsible for encoding which of the following antigens?
A. Only D antigen
B. C and E antigens
C. D and C antigens
D. Only E antigen
62. A person lacking the RHD gene will most likely have which blood type status
A. Rh-positive
B. Rh-negative
C. Blood type O
D. Blood type AB
63. Which of the following Rh antigens is the most immunogenic, meaning it is most likely to trigger an
immune response;
A. A antigen
B. B antigen
C. D antigen
D. O antigen
64. The presence or absence of Rh antigens can cause immune reactions in which of the following
situations?
A. Blood transfusion
B. Pregnancy
C. Organ transplant
D. Both A and B
65. Which of the following combinations can lead to hemolytic disease of the newborn (HDN)?
A. Rh-positive mother and Rh-positive fetus
B. Rh-negative mother and Rh-positive fetus
C. Rh-positive mother and Rh-negative fetus
D. Both are Rh-negative
66. The Rh antigen system is located on which chromosome in humans?
A. Chromosome 1
B. Chromosome 9
C. Chromosome 6
D. Chromosome 11
67. Which of the following Rh antigen configurations is most likely to result in a weak D phenotype?
A. Inheritance of two dominant D genes
B. A deletion in the RHD gene
C. Partial expression of the D antigen
D. Absence of the RHCE gene
68. Which of the following is true about Rh-null individuals;
A. They lack only the D antigen.
B. They lack all Rh antigens.
C. They have an excess of Rh antigens
D. They are immune to hemolytic disease.
69. The discovery of the Rh factor had a major impact on understanding and preventing which of the
following medical conditions;
A. Sickle cell anemia
B. Hemolytic disease of the newborn (HDN)
C. Blood clotting disorders
D. Cardiovascular diseases
70. Which transfusion reaction is associated with symptoms of fever, chills, flushing, headache,
anxiety, itching, and tachycardia without hemolysis?
A. Acute hemolytic transfusion reaction
B. Febrile non-hemolytic transfusion reaction (FNHTR)
C. Transfusion-associated circulatory overload (TACO)
D. TRALI
71. Which of the following is the most common type of transfusion reaction in recipient multiple
transfusions and in women who have had multiple pregnancies;
A. Acute hemolytic transfusion reaction
B. Febrile non-hemolytic transfusion reaction (FNHTR)
C. Transfusion-associated circulatory overload (TACO)
D. TRALI
72. Which transfusion reaction is most likely to occur due to ABO incompatibility;
A. Acute hemolytic transfusion reaction
B. Febrile non-hemolytic transfusion reaction (FNHTR)
C. Transfusion-associated circulatory overload (TACO)
D. TRALI
73. Which of the following is a primary symptom of Febrile Non-Hemolytic Transfusion Reaction;
A. Rash and itching
B. Fever and chills
C. Hypertension
D. Chest pain
74. Which of the following is the main cause of FNHTR?
A. Antibodies against transfused RBC antigens
B. Volume overload
C. Release of cytokines from leucocytes during storage of blood
D. Iron overload in repeated transfusions
75. Which immune mechanism is primarily involved in acute hemolytic transfusion reactions?
A. IgA-mediated allergic reaction
B. IgE-mediated allergic reaction
 C. IgG or IgM antibodies against donor red blood cells
D. Cytokine release from stored blood cells
76. What is the most common cause of mild allergic reactions during a blood transfusion?
A. ABO incompatibility
B. IgE-mediated response to plasma proteins in the donor blood
C. Iron overload
D. Contamination of blood products with bacteria
77. Which of the following is a characteristic symptom of a mild allergic transfusion reaction?
A. Hypotension and back pain
B. Fever and chills
C. Urticaria (hives) and itching
D. Shortness of breath and pulmonary edema
78. Which type of blood product is most commonly associated with allergic transfusion reactions;
A. Packed red blood cells
B. Platelets
C. Plasma containing products
D. Cryoprecipitate
79. Patients with an IgA deficiency are at higher risk for which type of transfusion reaction;
A. Febrile non-hemolytic transfusion reaction
B. Allergic or anaphylactic transfusion reaction
C. Delayed hemolytic transfusion reaction
D. Transfusion-associated circulatory overload (TACO)
80. If a patient has a known history of severe allergic reactions to transfusions, what pre-treatment
might help reduce reaction risk?
A. Administration of corticosteroids and antihistamines before transfusion
B. Giving diuretics before transfusion
C. Administering antibiotics before transfusion
D. Increasing the transfusion rate
81. In patients with TRALI, the chest X-ray typically shows:
A. Clear lung
B. Diffuse pulmonary infiltrates
C. Hydrothorax
D. Pneumothorax
82. Which of the following is considered a non-immunological transfusion reaction?
A. Allergic reaction
B. Hemolytic transfusion reaction
C. Transfusion-associated circulatory overload (TACO)
D. Anaphylactic reaction
83. Transfusion-associated circulatory overload (TACO) is more likely to occur in which type of patient?
A. Pediatric patients
B. Patients with a history of renal or heart disease
C. Patients with immune deficiencies
D. Patients with a history of multiple pregnancies
84. What is the primary risk factor for bacterial contamination in transfused blood products?
 A. Leukoreduction
B. Platelet storage at high temperature
C. Cold storage of packed red blood cells
D. Use of blood products from male donors
85. Which of the following symptoms is most likely associated with bacterial contamination of a blood
transfusion?
A. Urticaria and itching
B. Septicemic shock
C. Jaundice and dark-colored urine
D. Rash and elevated blood pressure
86. Which of the following conditions is associated with a rapid infusion of cold blood products, leading
to decreased body temperature?
A. Transfusion-associated dyspnea (TAD)
B. Hypothermia
C. Hyperkalemia
D. Iron overload
87. Which of the following blood components is most at risk for bacterial contamination?
A. Fresh frozen plasma
B. Platelets
C. Cryoprecipitate
D. Packed red blood cells
88. Bacterial contamination in blood products is most often due to;
A. Incorrect storage temperature
B. ABO incompatibility
C. Incomplete sterilization of skin during venipuncture
D. Immune response from the recipient
89. Which bacteria is most commonly associated with fatal bacterial contamination in blood products;
A. Escherichia coli
B. Yersinia enterocolitica
C. Staphylococcus aureus
D. Enterococcus faecalis
90. The presence of which symptom shortly after starting a transfusion might prompt suspicion of
bacterial contamination;
A. Urticaria
B. Shortness of breath
C. High fever with shaking chills
D. Mild increase in blood pressure
91. A transfusion reaction characterized by sudden onset of fever, hypotension, and shock shortly after
transfusion initiation is most likely due to;
A. ABO incompatibility
B. Bacterial contamination of the blood product
C. Anaphylactic reaction
D. Febrile non-hemolytic reaction
92. Delayed hemolytic transfusion reaction typically occurs how long after the transfusion?
 A. Within minutes to hours
B. 1 to 2 days
C. 5 to 10 days
D. 1 to 2 weeks
93. Which of the following is a potential delayed immunological complication following platelet
transfusion?
A. Transfusion-related acute lung injury (TRALI)
B. Post-transfusion purpura (PTP)
C. Graft-versus-host disease (GVHD)
D. Iron overload
94. Post-transfusion purpura is caused by the development of antibodies against:
A. HLA antigens
B. Platelet antigens (HPA)
C. ABO blood group antigens
D. Rh antigens
95. In post-transfusion purpura, thrombocytopenia typically occurs within:
A. 24 hours
B. 1 to 3 days
C. 5 to 10 days
D. 2 to 3 weeks
96. Which antigen is typically involved in delayed hemolytic transfusion reactions?
A. ABO antigens
B. Rh antigens
C. Kell antigens
D. HPA antigens
97. The primary treatment for transfusion-related iron overload is;
A. Corticosteroids
B. Iron chelation therapy
C. Bloodletting
D. Antibiotics
98. Hypocalcemia as a delayed non-immunological reaction is most commonly due to:
A. Iron overload
B. Hyperkalemia
C. Binding of calcium by citrate anticoagulant
D. Hemolysis
99. Hyperkalemia following blood transfusion is more likely with which of the following?
A. Freshly collected blood
B. Due to release of potassium from stored red cells
C. Leukoreduced blood
D. Irradiated blood
100. Which of the following is the first step in blood component preparation?
A. Leukoreduction
B. Centrifugation
C. Cross-matching
 D. Blood collection
101. The typical storage temperature for red blood cells (RBCs)?
A. 22-24°C
B. 2-6 °C
C. 10-20 °C
D. -80°C
102. What anticoagulant is commonly used during blood collection for component preparation?
A. Heparin
B. EDTA
C. Citrate phosphate dextrose (CPD)
D. Sodium fluoride
103. Which of the following methods is used to separate plasma from red blood cells in component
preparation?
A. Filtration
B. Centrifugation
C. Irradiation
D. Leukoreduction
104. Which of the following blood components is prepared by centrifugation of whole blood?
A. Plasma only
B. Red blood cells, plasma, and platelets
C. Red blood cells only
D. Cryoprecipitate only
105. Which blood component can be stored for up to 10 years if frozen with glycerol?
A. Platelets
B. Cryoprecipitate
C. Red blood cells
D. Plasma
106. Irradiation of red blood cell components is primarily done to prevent:
A. Iron overload
B. Graft-versus-host disease (GVHD)
C. Hypocalcemia
D. Hyperkalemia
107. What is the hematocrit level in a typical unit of packed red blood cells?
A. 20-30%
B. 55-65%
C. 65-80%
D. 90-100%
108. What is the typical shelf life of red blood cells stored in additive solutions?
A. 10 days
B. 21, 35, or 42 days
C. 56 days
D. 10 years
109. The process of freezing red blood cells in glycerol involves which step to protect the cells from
damage?
 A. Irradiation
B. Centrifugation
C. Cryopreservation
D. Leukoreduction
110. Which solution is used to wash red blood cells before transfusion?
A. Saline
B. Plasma
C. Glucose
D. Citrate
111. Which process is used to remove glycerol from red blood cells after thawing?
A. Leukoreduction
B. Washing with saline
C. Centrifugation
D. Irradiation
112. In which of the following conditions is washed red blood cells particularly indicated
A. Hemophilia
B. Autoimmune hemolytic anemia
C. IgA deficiency with anti-IgA antibodies
D. Thrombocytopenia
113. Which patients are most commonly indicated to receive irradiated red blood cells?
A. Patients with sickle cell anemia
B. Patients undergoing chemotherapy
C. Patients with severe bleeding disorders
D. Patients with IgA deficiency
114. After irradiation, what is the maximum storage period for red blood cells at 2-6°C
A. 7 days
B. 11 days
C. 28 days
D. 14 days
115. Which of the following conditions does not typically require irradiated red blood cells?
A. Bone marrow transplant recipients
B. Patients with Hodgkin lymphoma
C. Premature infants
D. Chronic anemia patients
116. Which of the following can be a potential risk of using non-irradiated blood in susceptible
patients?
A. Iron overload
B. Graft-versus-Host Disease (GVHD)
C. Hyperkalemia
D. Citrate toxicity
117. For which of the following situations is irradiation of red blood cells NOT typically required?
A. Intrauterine transfusions
B. Transfusions for patients with congenital immunodeficiency
C. Routine transfusions in healthy adults
 D. Transfusions from first-degree relatives
118. What is the typical storage temperature for platelet concentrates?
A. 1-6°C
B. 20-24°C
C. -18°C
D. 37°C
119. For how long can platelet concentrates be stored at the correct temperature with continuous
agitation?
A. 3 days
B. 4 days
C. 5 days
D. 10 days
120. What is the approximate increase in platelet count per unit of transfused platelets in an average
adult;
A. 5,000/µL
B. 10,000/µL
C. 20,000/µL
D. 50,000/µL
121. What is the primary component of Fresh Frozen Plasma (FFP)?
A. Red blood cells
B. Platelets
C. Coagulation factors
D. White blood cell
122. What is the typical storage temperature for Fresh Frozen Plasma (FFP)
A. 1-6°C
B. 22-24°C
C. -18 to -25°C
D. 37°C
123. For how long can FFP be stored at -18°C or colder?
A. 1 month
B. 3 months
C. 12 months
D. 24 months
124. What is the primary indication for transfusion of FFP
A. Thrombocytopenia
B. Anemia
C. Coagulation factor deficiencies
D. Leukopenia
125. Once thawed, how long can FFP be stored at 2-6°C before transfusion?
A. 4 hours
B. 12 hours
C. 24 hours
D. 5 days
126. What is the recommended thawing temperature for FFP?
 A. 1-6°C
B. 22-24°C
C. 30-37°C
D. 40-45°C
127. What is Cryoprecipitate primarily rich in?
A. Platelets
B. Factor VIII, fibrinogen, von Willebrand factor, Fibrononectin
C. Red blood cells
D. Albumin
128. What is the typical storage temperature for Cryoprecipitate?
A. 1-6°C
B. 22-24°C
C. -18°C or colder
D. 37°C
129. What is the typical content of fibrinogen in a unit of Cryoprecipitate?
A. 100 mg
B. 150 mg
C. 200 mg
D. 250 mg
130. Granulocyte transfusions are primarily used to treat which type of patients
A. Anemic patients
B. Patients with severe bacterial or fungal infections and neutropenia
C. Patients with clotting disorders
D. Patients with autoimmune diseases
131. What is the typical method used to collect granulocytes for transfusion?
A. Centrifugation of whole blood
B. Apheresis
C. Sedimentation
D. Filtration
132. What is the typical shelf life of granulocyte concentrates?
A. 5 days
B. 24 hours
C. 7 days
D. 72 hours
133. What type of antibodies is typically involved in Rh-related HDN?
A. IgA
B. IgG
C. IgM
D. IgE
134. Why does HDN often lead to jaundice in the affected newborn?
A. Liver enzyme deficiency
B. Increased bilirubin production due to hemolysis
C. Increased intestinal reabsorption of bilirubin
D. Decreased bilirubin conjugation
135. What is the primary immunological mechanism underlying the pathogenesis of HDN?
A. Bacterial infection leading to cell lysis
B. Maternal antibody-mediated destruction of fetal red blood cells
C. Fetal immune response against maternal cells
D. Genetic mutation causing red blood cell abnormalities
136. In HDN, which type of maternal antibodies are responsible for crossing the placenta and causing
hemolysis in the fetus?
A. IgA
B. IgG
C. IgM
D. IgE
137. Why is HDN typically more severe in subsequent pregnancies than in the first pregnancy in Rh
incompatibility?
A. Higher concentration of IgA antibodies
B. Sensitization occurs after the first pregnancy, leading to a stronger immune response in
later pregnancies
C. The fetus is more immunocompromised in later pregnancies
D. IgM antibodies are produced instead of IgG antibodies
138. Which organ in the fetus is responsible for filtering and destroying antibody-coated red blood
cells in HDN?
A. Liver
B. Spleen
C. Kidneys
D. Thymus
139. Which of the following is a possible consequence of severe anemia in the fetus due to HDN?
A. Polyhydramnios
B. Fetal growth restriction
C. Hydrops fetalis
D. Fetal hypoglycemia
140. Which of the following is a potential consequence of (bilirubin encephalopathy) results from
high levels of untreated indirect bilirubin (>20 mg/dL term infant with HDN).
A. Polycythemia
B. Kernicterus
C. Nephrotic syndrome
D. Hypertension
141. What is the most likely cause of jaundice in a newborn with HDN
A. Decreased liver enzyme activity
B. Excessive production of bilirubin due to hemolysis
C. Maternal hyperbilirubinemia
D. Gastrointestinal bleeding
142. A newborn presents with pallor, tachycardia, and hepatosplenomegaly. What is the likely cause
if the baby has a history of Rh incompatibility?
A. Neonatal sepsis
B. Hemolytic Disease of the Newborn
 C. Congenital hypothyroidism
D. Neonatal jaundice unrelated to hemolysis
143. What is the clinical significance of hepatosplenomegaly in a newborn with HDN?
A. It indicates liver failure.
B. It suggests extramedullary hematopoiesis due to anemia
C. It is a sign of congenital infection.
D. It indicates kidney dysfunction.
144. What skin color change might be observed in a newborn with HDN due to severe anemia?
A. Mottling
B. Cyanosis
C. Pallor
D. Erythema
145. Why is bilirubin neurotoxicity a concern in newborns with HDN
A. It leads to excessive erythropoiesis in the newborn.
B. Unconjugated bilirubin can cross the blood-brain barrier and cause brain damage
C. Conjugated bilirubin levels are elevated, causing liver failure.
D. It decreases the oxygen-carrying capacity of hemoglobin
146. The most common presentation of ABO HDN is;
A. Hydrops fetalis
B. Edema
C. Jaundic
D. Anemia
147. Hemophilia A is caused by a deficiency of which clotting factor
A. Factor V
B. Factor VII
C. Factor VIII
D. Factor XI
148. Hemophilia B, also known as Christmas disease, is associated with a deficiency of which clotting
factor?
A. Factor V
B. Factor X
C. Factor IX
D. Factor XI
149. Hemophilia C, which is Acquired Haemophilia is caused by a deficiency of which clotting factor
A. Factor V
B. Factor X
C. Factor IX
D. Factor XI
150. Which of the following is the pattern of inheritance for hemophilia A and B?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Mitochondrial inheritance
151. Who is most likely to be affected by hemophilia?
 A. Males
B. Females
C. Both males and females equally
D. Newborns only
152. A severe hemophilia patient presents with spontaneous bleeding. What factor level percentage
is typically associated with severe hemophilia?
A. Greater than 50%
B. 20-30%
C. 5-10%
D. Less than 1%
153. What is the risk of hemophilia in a male child born to a mother who is a carrier of the
hemophilia gene?
A. 0%
B. 50%
C. 25%
D. 75%
154. If a man with hemophilia has children, what is the likelihood that his sons will have the disease
A. 0%
B. 50%
C. 25%
D. 75%
155. What is the likelihood that a man with hemophilia will have a daughter who is a carrier?
A. 0%
B. 50%
C. 25%
D. 100%
156. A carrier mother and an unaffected father have a child. What is the chance that the child will be
an unaffected son;
A. 0%
B. 50%
C. 25%
D. 100%
157. When both parents are affected by hemophilia (an extremely rare situation since affected
females are uncommon), the chances for their children to have hemophilia is;
A. 100% sons only
B. 100% daughters only
C. 100 % chances for all children( both son and daughter)
D. 50% chances for all children
158. The mother is a carrier of hemophilia (XʰX) and the father is affected (XʰY), the likelihood that a
child will be an affected son;
A. 0%
B. 50%
 C. 25%
D. 100%
159. The mother is a carrier of hemophilia (XʰX) and the father is affected (XʰY), the likelihood that a
child will be unaffected son;
A. 0%
B. 50%
C. 25%
D. 100%
160. The mother is a carrier of hemophilia (XʰX) and the father is affected (XʰY), the likelihood that a
child will be a carrier daughter
A. 0%
B. 50%
C. 25%
D. 100%
161. The mother is a carrier of hemophilia (XʰX) and the father is affected (XʰY), the likelihood that a
child will be an affected daughter
A. 0%
B. 50%
C. 25%
D. 100%

Explanation of the above 158 to 161 mcqs.

Possible Offspring and Their Chances:

Mother’s X Chromosome Father’s Chromosome Child’s Genotype Phenotype

X Xʰ XXʰ Carrier daughter

X Y XY Unaffected son

Xʰ Xʰ XʰXʰ Affected daughter

Xʰ Y XʰY Affected son

Probabilities:

1. Daughters:
o 50% chance of being carriers (XʰX).
o 50% chance of being affected (XʰXʰ).
2. Sons:
o 50% chance of being unaffected (XY).
 o 50% chance of being affected (XʰY).

162. If a woman with hemophilia (XʰXʰ) has children with a normal father (XY), what is the probability
that a daughter will be a carrier of hemophilia?
A. 0%
B. 50%
C. 25%
D. 100% (All daughters inherit one affected X chromosome (Xʰ) from their mother, making
them carriers (XʰX).)
163. A mother with hemophilia (XʰXʰ) and a normal father (XY) are expecting a child. What is the
chance that their child will be unaffected?
A. 0% (None of the children can be unaffected because all inherit at least one X chromosome
with the hemophilia mutation from the mother.)
B. 50%
C. 25%
D. 100%
164. A mother with hemophilia (XʰXʰ) and a normal father (XY) are expecting a child. What is the
chance that their child will be affected son:
A. 0%
B. 25%
C. 50%
D. 100% (All sons inherit the affected X chromosome (Xʰ) from their mother, making them
affected (XʰY)
165. What is the genotype of a daughter born to a mother with hemophilia (XʰXʰ) and a normal
father (XY)?
A. XX
B. XʰX (The daughter inherits one affected X chromosome (Xʰ) from the mother and one normal
X chromosome from the father)
C. XʰY
D. XY
166. If a mother with hemophilia has a son, what is his expected phenotype
A. Normal
B. Carrier
C. Affected (The son inherits the affected X chromosome (Xʰ) from his mother and a Y
chromosome from his father, resulting in an affected phenotype (XʰY)
D. Unaffected
167. Why are daughters of an affected mother (XʰXʰ) and a normal father (XY) not affected by
hemophilia?
A. They inherit two normal X chromosomes
 B. They inherit a Y chromosome from their father
C. They inherit a normal X chromosome from their father (The normal X chromosome from the
father prevents the daughters from being affected, making them carriers instead)
D. They have a dominant form of the gene

Parental Genotypes:

 Mother (affected): XʰXʰ

 Father (normal): XY

Possible Genotypes of Children:

Mother’s X Chromosome Father’s Chromosome Child’s Genotype Phenotype

Xʰ X XʰX Carrier daughter

Xʰ Y XʰY Affected son

168. Which of the following is the most common clinical feature of hemophilia?
A. Petechiae
B. Hemarthrosis
C. Hematuria
D. Epistaxis
169. A prolonged aPTT (activated partial thromboplastin time) with a normal platelet count is
typically seen in:
A. Hemophilia A and B
B. von Willebrand disease
C. Immune thrombocytopenic purpura (ITP)
D. Disseminated intravascular coagulation (DIC)
170. The severity of hemophilia is classified based on the level of:
A. Hemoglobin
B. Factor VIII or IX activity
C. Platelet count
D. Fibrinogen level
171. Which of the following is the best initial diagnostic test for a suspected case of hemophilia?
A. Complete blood count (CBC)
 B. Prothrombin time (PT)
C. Activated partial thromboplastin time (aPTT)
D. D-dimer test
172. Which variant of hemoglobin is predominant in fetal life
A. Hemoglobin A
B. Hemoglobin F(Major Hemoglobin of Intra-uterine life is Hgb F)
C. Hemoglobin S
D. Hemoglobin C
173. Which of the following is the primary form of hemoglobin during the first few weeks of
embryonic development?
A. Hemoglobin A
B. Hemoglobin S
C. Hemoglobin C
D. Hgb Gower 1 (ζ2,ε2)
174. Which chains are present in embryonic hemoglobin Gower-1?
A. Two alpha (α) and two beta (β) chains
B. Two epsilon (ε) and two zeta (ζ) chains
C. Two gamma (γ) and two delta (δ) chains
D. Two beta (β) and two gamma (γ) chains
175. Hemoglobin Portland is composed of which globin chains?
A. Two alpha (α) and two beta (β) chains
B. Two zeta (ζ) and two gamma (γ) chains
C. Two epsilon (ε) and two delta (δ) chains
D. Two alpha (α) and two gamma (γ) chains
176. At what stage of development does embryonic hemoglobin typically get replaced by fetal
hemoglobin (HbF)?
A. 2-4 weeks of gestation
B. 5-10 weeks of gestation
C. 12-14 weeks of gestation
D. At birth
177. Which hemoglobin is the last to be produced during the embryonic stage before switching to
fetal hemoglobin (HbF)?
 A. Hemoglobin A
B. Hemoglobin Portland
C. Hemoglobin Gower-1
D. Hemoglobin Gower-2
178. Which of the following embryonic hemoglobins contains epsilon (ε) chains?
A. Hemoglobin A
B. Hemoglobin Portland
C. Hemoglobin F
D. Hemoglobin Gower-2
179. How many functional alpha-globin genes are present in the normal human genome?
A. 1
B. 2
C. 3
D. 4
180. How many functional beta-globin genes are present in the normal human genome?
A. 1
B. 2
C. 3
D. 4
181. What is the regulatory region called that controls the expression of the beta-globin gene
cluster?
A. TATA box
B. Enhancer element
C. Locus control region (LCR)
D. Polyadenylation site
182. Which gene in the beta-globin cluster is primarily expressed in fetal life?
A. Beta (β)
B. Gamma (γ)
C. Delta (δ)
D. Epsilon (ε)
183. Thalassemia is primarily a disorder affecting which part of the body?
A. Heart
 B. Lungs
C. Red blood cells
D. Liver
184. Thalassemia is inherited in which manner?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant
D. X-linked recessive
185. The genetic defect in thalassemia primarily affects the synthesis of
A. Platelets
B. White blood cells
C. Hemoglobin
D. Plasma
186. What type of mutation is most commonly associated with beta thalassemia?
A. Deletion of the beta-globin gene
B. Insertion mutation
C. Point mutation
D. Chromosomal translocation
187. Hemoglobin H disease, a form of alpha thalassemia, results from:
A. Loss of all four alpha-globin genes
B. Loss of three out of four alpha-globin genes
C. Mutation in the beta-globin gene
D. Deletion of both beta-globin genes
188. α-thalassemia (silent carrier ) a form of alpha thalassemia, results from;
A. Loss of all four alpha-globin genes
B. Loss of three out of four alpha-globin genes
C. Mutation in the beta-globin gene
D. One of the four α- globin gene fails to function
189. α-thalssemia-trait (α Thal trait minor) a form of alpha thalassemia, results from;
A. Loss of all four alpha-globin genes
B. Loss of three out of four alpha-globin genes
C. Two of the four α-globin gene fails to functions.
 D. One of the four α- globin gene fails to function
190. Bart’s Hydops Fetalis ) a form of alpha thalassemia, results from;
A. Loss of all four alpha-globin genes
B. Loss of three out of four alpha-globin genes
C. Two of the four α-globin gene fails to functions.
D. One of the four α- globin gene fails to function
191. The most common genetic cause of alpha thalassemia is:
A. Point mutation
B. Gene duplication
C. Gene deletion
D. Chromosomal translocation
192. In alpha thalassemia, the loss of one alpha-globin gene (–α/αα) results in
A. Hemoglobin H disease
B. Alpha thalassemia trait
C. Silent carrier state
D. Alpha thalassemia major
193. What is the clinical outcome of Alpha Thalassemia Major if untreated?
A. Lifelong asymptomatic condition
B. Development of hemoglobin H disease
C. Severe anemia, often fatal in utero (hydrops fetalis)
D. Iron overload syndrome
194. Alpha Thalassemia Major is typically caused by the deletion of:

A. One alpha-globin gene

B. Two alpha-globin genes
C. Three alpha-globin genes
D. All four alpha-globin genes
195. The presence of which type of hemoglobin is a hallmark of Alpha Thalassemia Major in
fetal blood?
A. Hemoglobin F (HbF)
B. Hemoglobin A (HbA)
C. Hemoglobin Barts (γ4)
D. Hemoglobin S (HbS)

196. Which of the following is a common complication of a surviving infant with Alpha
Thalassemia Major post-treatment?
A. Heart failure
 B. Iron deficiency anemia
C. Iron overload due to frequent transfusions
D. Sickle cell crisis
197. The formation of Hemoglobin Barts (γ4) in Alpha Thalassemia Major leads to:
A. Effective oxygen transport
B. Inefficient oxygen delivery and high oxygen affinity
C. Increased red blood cell lifespan
D. Normal hemoglobin electrophoresis results
198. Which of the following is an important prenatal sign of Alpha Thalassemia Major
detected via ultrasound?
A. Fetal growth acceleration
B. Fetal liver enlargement and ascites
C. Oligohydramnios
D. Normal fetal anatomy
199. What is the most likely cause of death in untreated cases of Alpha Thalassemia Major?
A. Respiratory failure
B. Severe cardiac complications due to anemia and hydrops fetalis
C. Infections due to immunosuppression
D. Liver cirrhosis
200. Which physical sign is most likely present in a fetus affected by Alpha Thalassemia Major?
A. Clubbing of fingers
B. Large abdominal circumference due to ascites
C. Petechial rash
D. Cyanosis of the lips
201. The severe anemia in Alpha Thalassemia Major leads to which compensatory
mechanism?
A. Decreased erythropoiesis
B. Extramedullary hematopoiesis, resulting in hepatosplenomegaly
C. Increased white blood cell count
D. Hyperglycemia2
202. The severe hypoxia in Alpha Thalassemia Major is primarily due to:
A. Decreased red blood cell count
B. Inefficient oxygen transport by hemoglobin Barts
C. Decreased erythropoietin production
D. Excess production of hemoglobin A
203. What is a common sign on physical examination of an infant born with Alpha
Thalassemia Major?
A. Tremors
B. Enlarged liver and spleen (hepatosplenomegaly)
C. Blue sclera
D. Hyperactive reflexes
204. Which of the following is a possible early prenatal sign of Alpha Thalassemia Major on
ultrasound?
A. Normal fetal anatomy
 B. Small placental size
C. Cardiomegaly
D. Decreased fetal growth
205. What is the typical finding on a peripheral blood smear in Alpha Thalassemia Major?
A. Microcytic hypochromic red cells with target cells
B. Macrocytes and megaloblasts
C. Rouleaux formation
D. Spherocytes
206. Which of the following hemoglobin electrophoresis results is most indicative of Alpha
Thalassemia Major?
A. Normal levels of HbA with increased HbA2
B. Absence of HbA and presence of a high level of Hb Barts
C. Predominantly HbF with decreased HbA
D. Elevated HbA2 and HbC
207. What is the most common finding in a complete blood count (CBC) for Alpha
Thalassemia Major?
A. High hemoglobin levels
B. Normal RBC count and size
C. Severe anemia with low MCV and low MCH (mean corpuscular hemoglobin)
D. High white blood cell count
208. Which of the following results on a complete blood count (CBC) would strongly suggest
Alpha Thalassemia Major?
A. High mean corpuscular volume (MCV)
B. Normal red blood cell distribution width (RDW)
C. Low hemoglobin and low mean corpuscular hemoglobin (MCH)
D. High platelet count
209. Which of the following is the most common cause of Hemoglobin H disease?
A. Mutation in the beta-globin gene
B. Mutation in the gamma-globin gene
C. Deletion of three alpha-globin genes
D. Deletion of all four alpha-globin genes
210. A characteristic finding in Hemoglobin H disease on a peripheral blood smear is:
A. Sickle cells
B. Howell-Jolly bodies
C. Heinz bodies
D. Spherocytes
211. Which type of anemia is typically seen in Hemoglobin H disease?
A. Macrocytic anemia
B. Normocytic anemia
C. Microcytic hypochromic anemia
D. Hemolytic anemia with increased MCV
212. A key feature differentiating Hemoglobin H disease from more severe alpha-
thalassemia (such as hydrops fetalis) is:
A. Presence of Hemoglobin Bart’s
 B. Presence of only two alpha-globin gene deletions
C. Compatibility with life without intensive medical intervention
D. Hemoglobin levels above 14 g/dL
213. Hemoglobin H (HbH) consists of which type of globin chains?
A. Two alpha and two beta chains
B. Four alpha chains
C. Four beta chains
D. Two alpha and two delta chains
214. The increased oxygen affinity of Hemoglobin H results in:
A. Efficient oxygen delivery to tissues
B. Reduced oxygen delivery and tissue hypoxia
C. Normal oxygen delivery but reduced hemoglobin stability
D. Severe methemoglobinemia
215. Which of the following is a characteristic laboratory finding in thalassemia trait?
A. Normal mean corpuscular volume (MCV)
B. Microcytic hypochromic red blood cells
C. Elevated white blood cell count
D. Increased platelet count
216. What is the most common clinical feature of thalassemia trait?
A. Severe anemia
B. No symptoms or mild anemia
C. Frequent infections
D. Bone deformities
217. In alpha-thalassemia trait, how many of the four alpha-globin genes are usually deleted or
nonfunctional?
A. ONE
B. TWO
C. Three
D. Four
218. Which treatment is typically required for individuals with thalassemia trait?
A. Regular blood transfusions
B. Bone marrow transplantation
C. Iron supplements
D. No specific treatment is usually require
219. What is the shape of red blood cells in individuals with thalassemia trait?
A. Normal biconcave
B. Target cells (codocytes)
C. Sickle-shaped
D. Fragmented cell
220. The presence of which type of hemoglobin indicates alpha-thalassemia?
A. Hemoglobin Bart’s in newborns
B. Hemoglobin S
C. Hemoglobin E
D. Hemoglobin A
221. What is the primary cause of beta-thalassemia
A. Deletion of alpha-globin genes
B. Point mutations in beta-globin genes
C. Iron deficiency
D. Overproduction of hemoglobin A2
222. Which type of beta-thalassemia is most severe?
A. Beta-thalassemia minor
B. Beta-thalassemia intermedia
C. Beta-thalassemia major
D. Silent carrier of beta-thalassemia
223. What is the alternate name for beta-thalassemia major?
A. Cooley's anemia
B. Mediterranean anemia
C. Sickle-cell anemia
D. Hemoglobinopathy anemia
224. Which clinical feature is characteristic of beta-thalassemia major?

A. Normal growth and development

B. Severe anemia requiring regular blood transfusions
C. Asymptomatic presentation
D. Normal hemoglobin levels
225. What is the usual treatment for beta-thalassemia major?
A. Iron supplementation
B. Bone marrow transplantation
C. Lifestyle changes
D. Antibiotic therapy
226. Which finding on a peripheral blood smear suggests beta-thalassemia?
A. Macrocytosis
B. Target cells and basophilic stippling
C. Hypersegmented neutrophils
D. Spherocytes
227. Why do skeletal deformities occur in beta-thalassemia major?
A. Iron deficiency affects bone development
B. Expansion of bone marrow to compensate for increased erythropoiesis
C. Direct damage to bone tissue by unpaired alpha-globin chains
D. High levels of calcium in the blood
228. In beta-thalassemia, increased erythropoietic drive leads to:
 A. Hepatic fibrosis
B. Secondary hyperplasia of the bone marrow
C. Iron depletion in tissues
D. Increased oxygen delivery to tissues
229. What is the gold standard test for diagnosing beta-thalassemia?
A. Complete blood count (CBC)
B. Peripheral blood smear
C. Hemoglobin electrophoresis
D. Serum ferritin levels
230. In beta-thalassemia major, which hemoglobin variant is commonly elevated?
A. Hemoglobin A
B. Hemoglobin C
C. Hemoglobin F
D. Hemoglobin H
231. How does beta-thalassemia affect the reticulocyte count?
A. Decreased due to bone marrow suppression
B. Normal in all cases
C. Increased due to ineffective erythropoiesis
D. Decreased due to decreased erythropoietin levels
232. What does a bone marrow examination show in beta-thalassemia major?
A. Normal erythropoiesis
B. Hypoplastic marrow
C. Hyperplasia of erythroid precursors
D. Fibrotic changes
233. Which clinical presentation is typical of beta-thalassemia minor
A. Severe anemia requiring transfusions
B. Mild or asymptomatic anemia
C. Bone deformities and growth retardation
D. Jaundice and splenomegaly
234. Which of the following is a typical finding in the peripheral blood smear of beta-thalassemia
minor?
A. Normocytic normochromic cells
 B. Microcytosis and hypochromia with target cells
C. Macrocytosis with Howell-Jolly bodies
D. Spherocytes and rouleaux formation
235. What is the expected hemoglobin A2 level in beta-thalassemia minor;
A. Decreased (<2.5%)
B. Normal (2.5–3.5%)
C. Elevated (>3.5%)
D. Absent
236. Which of the following is the characteristic genotype of beta-thalassemia intermedia?
A. Homozygous β0 mutation
B. Compound heterozygous β0/β+ mutation
C. Heterozygous β+ mutation
D. Homozygous β+ mutation
237. The clinical severity of beta-thalassemia intermedia is primarily due to which of the following
factors?
A. Increased fetal hemoglobin (HbF) production
B. Complete absence of beta-globin chains
C. Iron overload at birth
D. Increased erythropoiesis
238. What is the hallmark feature of aplastic anemia causing pancytopenia?
A. Bone marrow hyperplasia
B. Bone marrow hypoplasia or aplasia
C. Excessive destruction of blood cells
D. Splenic sequestration
239. What is the typical finding in the bone marrow of a patient with aplastic anemia?
A. Hypercellularity with blasts
B. Fatty infiltration with hypocellularity
C. Fibrosis with increased megakaryocytes
D. Granulomas with necrosis
240. Pancytopenia in myelodysplastic syndrome is primarily due to:
A. Ineffective hematopoiesis
B. Increased destruction of blood cells
 C. Bone marrow aplasia
D. Hypersplenism
241. Which of the following is NOT a common feature of pancytopenia?
A. Fatigue due to anemia
B. Petechiae and purpura due to thrombocytopenia
C. Increased risk of infections due to leukopenia
D. Polycythemia
242. What is the primary pathological mechanism in aplastic anemia?
A. Overproduction of red blood cells
B. Bone marrow suppression or failure
C. Increased destruction of red blood cells
D. Infiltration of bone marrow by malignant cells
243. Which inherited disorder is commonly associated with aplastic anemia?
A. Fanconi anemia
B. Sickle cell anemia
C. Hereditary spherocytosis
D. Hemophilia
244. Which blood cell line is typically affected in aplastic anemia?
A. Red blood cells only
B. White blood cells only
C. Platelets only
D. All blood cell lines
245. What is the hallmark laboratory finding in aplastic anemia?
A. Pancytopenia with a low reticulocyte count
B. Leukocytosis with elevated neutrophils
C. Thrombocytosis with macrocytosis
D. Anemia with elevated ferritin levels
246. Fanconi anemia, an inherited form of aplastic anemia, is commonly associated with which of the
following?
A. Short stature and café-au-lait spots
B. Increased hemoglobin A2 levels
C. Normal chromosomal breakage test
 D. Macrocytosis without pancytopenia
247. Which test is used to confirm the inherited nature of aplastic anemia, such as Fanconi anemia?
A. Chromosomal breakage test with diepoxybutane (DEB)
B. Flow cytometry for CD55/CD59
C. Bone marrow biopsy
D. Peripheral blood smear
248. Which of the following is the most common cause of acquired aplastic anemia?
A. Ionizing radiation
B. Viral infections
C. Idiopathic (unknown cause)
D. Drug-induced
249. Which toxin is well-known to cause aplastic anemia?
A. Benzene
B. Carbon monoxide
C. Arsenic
D. Methanol
250. Which of the following conditions is classified as secondary aplastic anemia?
A. Radiation-induced aplastic anemia
B. Idiopathic aplastic anemia
C. Fanconi anemia
D. Dyskeratosis congenital
251. Which of the following viral infections is most strongly associated with aplastic anemia?
A. HIV
B. Coronavirus
C. Hepatitis viruses (non-A, non-B)
D. Epstein-Barr virus
252. What is the most likely cause of aplastic anemia in a patient exposed to agricultural pesticides?
A. Viral infection
B. Benzene toxicity
C. Organophosphate poisoning
D. Chloramphenicol usage
253. Which of the following best describes aplastic anemia?
 A. Excessive destruction of red blood cells
B. A clonal proliferation of myeloid cells
C. A bone marrow failure syndrome characterized by pancytopenia
D. Increased production of abnormal hemoglobin
254. Which immune mechanism plays a significant role in the pathogenesis of idiopathic aplastic
anemia?
A. Overactivity of B lymphocytes
B. Overproduction of complement proteins
C. Cytotoxic T-cell mediated suppression of hematopoietic stem cells
D. Autoantibodies against erythrocytes
255. A common symptom of aplastic anemia due to anemia is:
A. Shortness of breath on exertion
B. Hemarthrosis
C. Neurological symptoms
D. Splenomegaly
256. The bleeding tendency in aplastic anemia is primarily due to:
A. Decreased platelet count (thrombocytopenia)
B. Decreased red blood cells (anemia)
C. Increased white blood cells (leukocytosis)
D. Abnormal clotting factors
257. Which of the following symptoms is associated with leukopenia in aplastic anemia?
A. Increased fatigue
B. Recurrent infections
C. Petechiae and purpura
D. Generalized edema
258. Petechiae and ecchymoses in a patient with aplastic anemia are due to:
A. Iron deficiency anemia
B. Low platelet count
C. High reticulocyte count
D. Vitamin B12 deficiency
259. A 25-year-old patient with aplastic anemia presents with fatigue, frequent nosebleeds, and
recurrent infections. Which laboratory finding would most likely correlate with their clinical
presentation?
A. Isolated anemia
B. Pancytopenia with hypocellular bone marrow
C. Leukocytosis with normal platelet count
D. Increased reticulocyte count
260. Which symptom is most commonly reported in patients with aplastic anemia due to
thrombocytopenia?
A. Night sweats
B. Easy bruising and bleeding
C. Dizziness and fainting
D. Bone pain
261. Which of the following is a systemic complication of prolonged aplastic anemia?
A. Progression to acute leukemia
B. Secondary hemochromatosis
C. Iron deficiency anemia
D. Pulmonary hypertension
262. Short stature in a child with Fanconi anemia is often due to:
A. Nutritional deficiencies
B. Endocrine abnormalities such as growth hormone deficiency
C. Chronic hypoxia
D. Recurrent infections
263. Which malignancy is most strongly associated with Fanconi anemia?
A. Acute myeloid leukemia (AML)
B. Hodgkin’s lymphoma
C. Burkitt’s lymphoma
D. Non-small cell lung cancer
264. Which congenital abnormality is most commonly associated with Fanconi anemia?
A. Polydactyly
B. Radial ray defects (e.g., absent thumb, hypoplastic radius)
C. Spina bifida
 D. Macrocephaly
265. What is the typical age of onset for the clinical manifestations of Fanconi anemia?
A. Neonatal period
B. Early childhood (5–10 years)
C. Late adolescence
D. Adulthood (20–30 years
266. G6PD deficiency affects which of the following metabolic pathways?
A. Glycolysis
B. Tricarboxylic acid cycle
C. Pentose phosphate pathway
D. Urea cycle
267. What is the genetic basis of G6PD deficiency
A. Autosomal dominant inheritance
B. Autosomal recessive inheritance
C. X-linked recessive inheritance
D. Mitochondrial inheritance
268. A classic example of a drug that can precipitate hemolysis in G6PD-deficient individuals is:
A. Paracetamol
B. Diuretics
C. Primaquine(Anti-malarial)
D. Metformin
269. Which food is known to trigger hemolysis in G6PD deficiency?
A. Soy
B. Fava beans
C. Milk
D. Wheat
270. G6PD deficiency protects against which infectious disease?
A. Malaria
B. Tuberculosis
C. Typhoid fever
D. Dengue fever
271. Which of the following triggers hemolysis in G6PD-deficient individuals?
 A. Hypoglycemia
B. Oxidative stress(The inflammatory response to infection results in the generation of free
radicals in macrophages, which can diffuse into the red blood cells and cause oxidative
damage.

C. Hypoxia
D. Alkalosis
272. The inheritance of G6PD deficiency results in which group being most commonly affected?
A. Females exclusively
B. Males predominantly
C. Both males and females equally
D. Neither males nor females
273. G6PD deficiency is most common in populations from which geographic regions?
A. Northern Europe
B. Sub-Saharan Africa, the Mediterranean, and Southeast Asia
C. Central America
D. East Asia
274. In G6PD deficiency, which of the following is typically seen on a peripheral blood smear during
hemolysis?
A. Hypersegmented neutrophils
B. Spherocytes
C. Bite cells and blister cells
D. Howell-Jolly bodies
275. In G6PD deficiency, the lack of NADPH leads to:
A. Increased oxidative damage to the red blood cell membrane
B. Reduced ATP production
C. Increased oxygen delivery to tissues
D. Enhanced production of reactive oxygen species (ROS)
276. During oxidative stress, hemoglobin in G6PD-deficient red blood cells forms aggregates called:
A. Howell-Jolly bodies
B. Heinz bodies
 C. Pappenheimer bodies
D. Basophilic stippling
277. Which of the following mechanisms triggers hemolysis during oxidative stress in G6PD
deficiency?
A. Increased oxygen consumption by red blood cells
B. Lipid peroxidation of the red blood cell membrane
C. Overproduction of erythropoietin
D. Increased binding of hemoglobin to red blood cell membranes
278. Which of the following best describes the pathophysiology of bite cells in G6PD deficiency?
A. They result from defective erythropoiesis in the bone marrow.
B. Macrophages remove Heinz bodies, leaving "bites" in the cell membrane.
C. They are a consequence of excessive hemoglobin synthesis
D. Oxidative stress induces their formation through direct lysis.
279. The G6PD Mediterranean variant is classified as which WHO class?
A. Class I
B. Class II
C. Class III
D. Class IV
280. Which G6PD variant is most common in Mediterranean populations?
A. G6PD Canton
B. G6PD Mediterranean
C. G6PD A-
D. G6PD Kaiping
281. The G6PD Canton variant is primarily observed in:
A. African populations
B. Mediterranean populations
C. East Asian populations
D. South American populations
282. Which of the following is a common clinical feature of G6PD deficiency?
A. Persistent jaundice in adulthood
B. Episodic hemolysis triggered by oxidative stress
C. Macrocytic anemia with hypersegmented neutrophils
 D. Pancytopenia
283. A newborn with G6PD deficiency is most at risk for which of the following conditions?
A. Persistent neonatal jaundice
B. Hemarthrosis
C. Recurrent bacterial infections
D. Hypercalcemia
284. Which of the following is a reliable indicator of oxidative damage to red blood cells in G6PD
deficiency?
A. Presence of spherocytes
B. Presence of schistocytes
C. Presence of bite cells on a peripheral smear
D. Hypersegmented neutrophils
285. Which lab test provides evidence of increased erythropoietic activity in response to hemolysis in
G6PD deficiency?
A. Hemoglobin electrophoresis
B. Reticulocyte count
C. Osmotic fragility test
D. Coombs test
286. Which of the following tests can be used to detect G6PD deficiency during a hemolytic episode?
A. Fluorescent spot test for NADPH
B. Direct antiglobulin test (Coombs test)
C. Serum ferritin levels
D. Bone marrow biopsy
287. What would the peripheral blood smear show in G6PD deficiency immediately after a hemolytic
episode?
A. Schistocytes and hypochromic RBCs
B. Increased reticulocytes and polychromasia
C. Spherocytes and microspherocytes
D. Microcytes and tear-drop cells
288. What is the typical finding of serum haptoglobin in G6PD-related hemolysis?
A. Increased
B. Decreased
 C. Normal
D. Unaffected
289. Which of the following is the most reliable laboratory indicator of intravascular hemolysis in
G6PD deficiency?
A. Increased plasma haptoglobin
B. Decreased LDH levels
C. Free hemoglobin in the plasma
D. Normal bilirubin levels
290. Which of the following parameters remains unaffected in G6PD deficiency during an acute
hemolytic crisis?
A. Hemoglobin levels
B. Serum potassium
C. Platelet count
D. Reticulocyte count
291. What causes sickle cell anemia?
A. Lack of vitamin B12
B. A mutation in the HBB gene
C. Deficiency of iron in the diet
D. Viral infection
292. Sickle cell anemia primarily affects which component of the blood?
A. Platelets
B. White blood cells
C. Red blood cells
D. Plasma
293. Sickle cell anemia follows which pattern of inheritance?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Mitochondrial
294. The mutation in the HBB gene results in the substitution of which amino acid in hemoglobin?
A. Glutamic acid to valine
B. Glutamic acid to alanine
 C. Valine to leucine
D. Proline to glycine
295. The hemoglobin variant produced in sickle cell disease is called:
A. Hemoglobin C
B. Hemoglobin S
C. Hemoglobin E
D. Hemoglobin F
296. Sickle cell disease is inherited in an autosomal recessive pattern. Which of the following
genotypes indicates an individual with sickle cell disease?
A. AA
B. AS
C. SS
D. AC
297. An individual with sickle cell disease (SS) has parents with which genotypes?
A. AA and AA
B. AS and AS
C. AS and SS
D. AA and AS
298. An individual who inherits one sickle cell allele (S) and one normal allele (A) is considered to
have which of the following genotypes?
A. AA
B. AS(Trait)
C. SS
D. AC
299. Which of the following is true about individuals with sickle cell trait (AS)?
A. They have sickle cell disease
B. They have normal hemoglobin
C. They carry one sickle cell allele but typically do not show symptoms
D. They have hemoglobin F
300. Which of the following genotypes is most likely to result in a person being asymptomatic but a
carrier of sickle cell disease?
A. AS
 B. SS
C. AA
D. AC
301. What effect does the sickle cell mutation have on the hemoglobin molecule?
A. It decreases oxygen-carrying capacity
B. It causes the red blood cells to take on a rigid, sickle shape
C. It prevents red blood cells from being recycled in the spleen
D. It leads to an excess of red blood cells in the bloodstream
302. What is the result of the point mutation in sickle cell disease at the codon for hemoglobin?
A. The production of hemoglobin F
B. A change in amino acid from glutamic acid to valine
C. A change from valine to alanine
D. An increased rate of hemoglobin breakdown
303. Individuals with sickle cell trait (AS) have what kind of hemoglobin?
A. Hemoglobin A only
B. Hemoglobin S only
C. Both hemoglobin A and hemoglobin S
D. Both hemoglobin A and hemoglobin C
304. Which of the following is NOT a characteristic of a person with sickle cell trait as seen on
hemoglobin electrophoresis?
A. Presence of hemoglobin A
B. Presence of hemoglobin S
C. Presence of hemoglobin F
D. Presence of hemoglobin C
305. In sickle cell disease, the sickling of red blood cells is primarily triggered by:
A. Low oxygen levels
B. High oxygen levels
C. Vitamin D deficiency
D. Low pH (acidosis)
306. The vaso-occlusive crises in sickle cell disease occur when:
A. Sickle-shaped cells are too large to pass through small blood vessels
B. Red blood cells are lost in the urine
 C. White blood cells accumulate in the blood vessels
D. Platelets aggregate to form clots in arteries
307. Vaso-occlusion in sickle cell disease results in which of the following?
A. Organ ischemia
B. Excessive blood clotting
C. Reduced platelet function
D. Increased white blood cell count
308. The most common type of pain associated with sickle cell disease is:
A. Chest pain
B. Abdominal pain
C. Joint pain
D. Leg ulcers
309. Which of the following is a common complication of sickle cell disease that affects the lungs?
A. Acute chest syndrome
B. Pulmonary embolism
C. Pneumonia
D. Asthma
310. The primary cause of priapism in sickle cell disease is:
A. Impaired blood flow due to sickled cells
B. Inflammation of the penis
C. Bacterial infection
D. Hormonal imbalances
311. What is the lifespan of a sickled red blood cell compared to a normal red blood cell?
A. 120 days for both
B. 60 days for sickled cells, 120 days for normal cells
C. 10–20 days for sickled cells, 120 days for normal cells
D. 30 days for sickled cells, 100 days for normal cells
312. The polymerization of hemoglobin S in sickle cell disease is exacerbated by which of the
following factors?
A. Decreased pH (acidosis)
B. High temperature
C. High iron levels
 D. High blood pressure
313. splenic sequestration crisis in sickle cell anemia is characterized by;
A. A crisis caused by excessive destruction of red blood cells in the spleen
B. Intrasplenic trapping of red blood cells
C. A crisis caused by infection of the spleen
D. Spleen enlargement due to iron overload
314. Recurrent splenic sequestration crisis can lead to which of the following over time?
A. Autosplenectomy (functional asplenia)
B. Hepatomegaly
C. Chronic pulmonary hypertension
D. Chronic kidney disease
315. An aplastic crisis in sickle cell disease is typically caused by:
A. Paravirus B19 infection
B. Epstein-Barr virus (EBV) infection
C. Iron deficiency
D. Bacterial sepsis
316. Which of the following is a hallmark laboratory finding in an aplastic crisis?
A. Reticulocytopenia (low reticulocyte count)
B. Increased platelet count
C. Elevated reticulocyte count
D. Leukocytosis
317. A hemolytic crisis in sickle cell anemia is characterized by:
A. Sudden destruction of red blood cell
B. Suppression of bone marrow activity
C. Increased production of hemoglobin F
D. Decreased white blood cell count
318. Which of the following is commonly elevated in a hemolytic crisis?
A. Serum haptoglobin
B. Reticulocyte count
C. Hemoglobin levels
D. Platelet count
319. Which feature differentiates aplastic crisis from hemolytic crisis?
 A. Elevated bilirubin levels
B. Low reticulocyte count
C. Increased hemoglobin levels
D. Bone pain
320. In sickle cell anemia, the hemoglobin level is typically:
A. Elevated (>16 g/dL)
B. Normal (12-15 g/dL)
C. Decreased (6-9 g/dL)
D. Undetectable (<2 g/dL)
321. In patients with functional asplenia due to sickle cell anemia, the peripheral blood smear may
show:
A. Howell-Jolly bodies
B. Heinz bodies
C. Basophilic stippling
D. Siderocytes
322. Sideroblastic anemia is characterized by:
A. Decreased production of hemoglobin
B. Abnormal incorporation of iron into hemoglobin
C. Increased iron loss from the body
D. Autoimmune destruction of red blood cells
323. The hallmark feature of sideroblastic anemia on a bone marrow biopsy is:
A. Hypersegmented neutrophils
B. Ringed sideroblasts
C. Howell-Jolly bodies
D. Heinz bodies
324. Sideroblastic anemia is caused by defects in:
A. Iron absorption in the gut
B. Heme synthesis in erythroblasts
C. DNA synthesis in the bone marrow
D. Red blood cell membrane structure
325. Sideroblastic anemia can be classified as:
A. Only hereditary
 B. Only acquired
C. Both hereditary and acquired
D. A type of hemolytic anemia
326. Which enzyme deficiency is commonly associated with hereditary sideroblastic anemia?
A. Ferrochelatase
B. ALA synthase
C. ALA dehydratase
D. Uroporphyrinogen decarboxylase
327. Peripheral blood smear in sideroblastic anemia typically shows:
A. Microcytic, hypochromic red blood cells
B. Macrocytic red blood cells
C. Target cells and spherocytes
D. Normocytic, normochromic red blood cells
328. Which of the following genetic mutations is commonly associated with X-linked sideroblastic
anemia?
A. HFE gene
B. ALAS2 gene
C. SCL11A2 gene
D. TFR2 gene
329. Hereditary sideroblastic anemia is primarily inherited as:
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Mitochondrial inheritance
330. Prussian blue staining in bone marrow aspirates highlights
A. Hemosiderin deposits around erythroblasts
B. Reticulocytes in circulation
C. Mitochondrial DNA mutations
D. Hemoglobin precipitates
331. The key biochemical defect in hereditary sideroblastic anemia involves dysfunction in:
A. Heme synthesis
B. Iron absorption in the gut
 C. Ferritin transport
D. Erythropoietin production
332. Common clinical manifestations of sideroblastic anemia include:
A. Fatigue, weakness, and hepatosplenomegaly
B. Jaundice, joint pain, and neuropathy
C. Hematuria, proteinuria, and thrombosis
D. Fever, rash, and weight loss
333. Which of the following is the most common cause of megaloblastic anemia
A. Iron deficiency
B. Vitamin B12 deficiency
C. Lead poisoning
D. Hemolysis
334. Which of the following medications can lead to megaloblastic anemia?
A. Metformin
B. Methotrexate
C. Aspirin
D. Hydroxyurea
335. A dietary deficiency of folate is most commonly seen in
A. Vegans
B. Alcoholics
C. Pregnant women
D. Elderly individuals
336. Which of the following conditions increases the demand for folate, leading to megaloblastic
anemia?
A. Hypothyroidism
B. Pregnancy
C. Chronic kidney disease
D. Iron deficiency
337. In megaloblastic anemia, the characteristic finding in a peripheral blood smear is:
A. Microcytic hypochromic RBCs
B. Macrocytic RBCs with hypersegmented neutrophils
C. Target cells
 D. Sickle-shaped RBCs
338. Which laboratory finding is most consistent with megaloblastic anemia?
A. Increased reticulocyte count
B. Normal mean corpuscular volume (MCV)
C. Elevated MCV (>98 fL)
D. Low serum ferritin
339. A key finding in bone marrow aspirates in megaloblastic anemia is:
A. Ringed sideroblasts
B. Megaloblastic erythroid precursors
C. Hypocellular marrow
D. Increased iron stores
340. Prolonged untreated megaloblastic anemia may lead to:
A. Heart failure
B. Aplastic crisis
C. Pancytopenia
D. Acute leukemia
341. Which protein is essential for the absorption of Vitamin B12 in the ileum?
A. Transcobalamin
B. Intrinsic factor
C. Albumin
D. Haptoglobin
342. The major dietary sources of Vitamin B12 include:
A. Fruits and vegetables
B. Grains and cereals
C. Meat, fish, and dairy products
D. Nuts and seeds
343. Vitamin B12 is stored predominantly in the:
A. Kidneys
B. Bone marrow
C. Liver
D. Spleen
344. The first step in Vitamin B12 metabolism involves binding to which protein in the stomach?
 A. Intrinsic factor
B. R-binder (haptocorrin)
C. Albumin
D. Transferrin
345. Once absorbed, Vitamin B12 is transported in the bloodstream by:
A. Albumin
B. Transferrin
C. Transcobalamin II
D. Hemoglobin
346. Vitamin B12 is a cofactor in the conversion of:
A. Homocysteine to methionine
B. Propionyl-CoA to succinyl-CoA
C. Both A and B
D. Glutamate to alpha-ketoglutarate
347. A deficiency in Vitamin B12 impairs the synthesis of which compound?
A. Methionine
B. Glutathione
C. Heme
D. Glycine
348. Which clinical syndrome is associated with Vitamin B12 deficiency due to autoimmune
destruction of parietal cells?
A. Pernicious anemia
B. Fanconi anemia
C. Sideroblastic anemia
D. Diamond-Blackfan anemia
349. The active form of folate in the body is:
A. Dihydrofolate (DHF)
B. Tetrahydrofolate (THF)
C. Folinic acid
D. N5-methyl tetrahydrofolate
350. The primary dietary sources of folate include:
A. Dairy products
 B. Leafy green vegetables, fruits, and legumes
C. Fish and seafood
D. Grains and cereals
351. Folate absorption primarily occurs in the:
A. Ileum
B. Lower jejunum
C. Duodenum and upper jejunum
D. Colon
352. In megaloblastic anemia, the erythroid precursors in the bone marrow appear:
A. Smaller than normal
B. Larger than normal with open chromatin
C. Normal in size with condensed chromatin
D. Fragmented and apoptotic
353. Glossitis in megaloblastic anemia appears as:
A. A swollen, red, and painful tongue
B. A white-coated tongue
C. A dry and cracked tongue
D. A tongue with ulcers and patches
354. Gastrointestinal symptoms of megaloblastic anemia include:
A. Constipation and bloating
B. Diarrhea and anorexia
C. Abdominal pain with vomiting
D. None of the above
355. Neural tube defects in a fetus are related to a deficiency of:
A. Iron
B. Folate
C. Vitamin B12
D. Vitamin D
356. Cold immune hemolytic anemia (CIHA) is caused by
A. Warm-reactive IgG antibodies
B. Cold-reactive IgM antibodies
C. Immune complex deposition
 D. T-cell mediated cytotoxicity
357. The most common antibody implicated in cold agglutinin disease is:
A. IgE
B. IgG
C. IgM
D. IgA
358. What is the primary initiating factor in the pathophysiology of cold agglutinin disease?
A. IgG binding to RBCs at warm temperatures
B. IgM binding to RBCs at low temperatures
C. Direct destruction of RBC membranes by cytokines
D. Increased osmotic fragility of RBCs in cold environments
359. The complement pathway activated in cold agglutinin disease is the;
A. Classical pathway
B. Alternative pathway
C. Lectin pathway
D. Mixed pathway
360. A hallmark laboratory finding in cold agglutinin disease due to complement activation is:
A. Positive direct antiglobulin test (DAT) for C3d
B. Increased red cell distribution width (RDW)
C. Decreased ferritin levels
D. Elevated vitamin B12 levels
361. Cold agglutinin disease secondary to Mycoplasma pneumoniae infection is due to:
A. Cross-reactivity between Mycoplasma antigens and RBC antigens
B. Immune complex deposition in blood vessels
C. Direct production of IgM by infected RBCs
D. Mycoplasma-induced suppression of complement inhibitors
362. What causes the characteristic acrocyanosis in cold agglutinin disease?
A. Agglutination of RBCs in the extremities leading to ischemia
B. Increased levels of methemoglobin in cold environments
C. Vasoconstriction triggered by cold-reactive IgG
D. Immune complex deposition in peripheral arteries
363. The primary antibody involved in warm autoimmune hemolytic anemia is:
 A. IgA
B. IgE
C. IgG
D. IgM
364. Warm autoimmune hemolytic anemia occurs optimally at a temperature of:
A. 15°C
B. 22°C
C. 37°C
D. 42°C
365. In WAIHA, hemolysis is primarily:
A. Intravascular
B. Extravascular
C. Microangiopathic
D. Directly complement-mediated
366. The key site of RBC destruction in WAIHA is:
A. Spleen
B. Liver
C. Kidneys
D. Bone marrow
367. The major mechanism of RBC destruction in WAIHA is:
A. Activation of the classical complement pathway
B. Opsonization by IgG and phagocytosis by macrophages
C. Hemolysis due to thermal instability of RBCs
D. Direct attack by cytotoxic T cells
368. A common secondary cause of WAIHA is:
A. Mycoplasma pneumoniae infection
B. Lymphoproliferative disorders (e.g., lymphoma)
C. Cold exposure
D. Drug-induced immune reactions
369. Which autoimmune disease is most commonly associated with WAIHA?
A. Systemic lupus erythematosus (SLE)
B. Rheumatoid arthritis
 C. Sjögren's syndrome
D. Multiple sclerosis
370. Drug-induced WAIHA is commonly associated with which drug class?
A. Penicilline
B. Cephalosporins
C. Non-steroidal anti-inflammatory drugs (NSAIDs)
D. All of the above
371. Which hematologic malignancy is often associated with warm autoimmune hemolytic anemia?
A. Chronic lymphocytic leukemia (CLL)
B. Acute myeloid leukemia (AML)
C. Hodgkin's lymphoma
D. Multiple myeloma
372. The hallmark laboratory test for diagnosing WAIHA is:
A. Direct antiglobulin test (DAT) or Coombs test
B. Reticulocyte count
C. Peripheral blood smear
D. Serum bilirubin
373. In WAIHA, the direct antiglobulin test (DAT) typically detects:
A. IgM alone
B. IgG or C3d on the RBC surface
C. Free hemoglobin in the plasma
D. Antibodies against platelet glycoproteins
374. A characteristic finding on the peripheral blood smear in WAIHA is:
A. Schistocytes
B. Spherocytes
C. Target cells
D. Basophilic stippling
375. A key feature differentiating WAIHA from cold agglutinin disease is:
A. WAIHA involves IgG antibodies, while cold agglutinin disease involves IgM.
B. WAIHA occurs at colder temperatures.
C. WAIHA is mediated primarily by complement.
D. WAIHA causes intravascular hemolysis, whereas cold agglutinin disease does not.
376. The most common cause of iron deficiency anemia worldwide is:
A. Vitamin B12 deficiency
B. Folate deficiency
C. Chronic blood loss
D. Hemolysis
377. Which of the following populations is at the highest risk of developing iron deficiency anemia?
A. Adult males
B. Postmenopausal women
C. Pregnant women
D. Athletes
378. Iron deficiency anemia in adult males and postmenopausal females should prompt evaluation
for:
A. Hemolysis
B. Gastrointestinal blood loss
C. Vitamin C deficiency
D. Bone marrow failure
379. Which of the following dietary components inhibits iron absorption?
A. Vitamin C
B. Phytates (found in whole grains)
C. Protein
D. Fats
380. The earliest stage of iron deficiency is characterized by:
A. Low hemoglobin levels
B. Depleted iron stores in the bone marrow
C. Increased serum ferritin levels
D. Macrocytosis
381. In iron deficiency anemia, reduced hemoglobin synthesis leads to:
A. Normocytic anemia
B. Microcytic, hypochromic anemia
C. Macrocytic anemia
D. Spherocytic anemia
382. A classic symptom of iron deficiency anemia is:
 A. Jaundice
B. Pica (craving for non-food substances)
C. Splenomegaly
D. Petechiae
383. Restless legs syndrome is a neurological symptom associated with:
A. Megaloblastic anemia
B. Iron deficiency anemia
C. Thalassemia
D. Sickle cell anemia
384. The most sensitive marker for iron deficiency is:
A. Serum ferritin
B. Hemoglobin level
C. Mean corpuscular volume (MCV)
D. Reticulocyte count
385. A peripheral blood smear in iron deficiency anemia typically shows:
A. Macrocytosis and hypersegmented neutrophils
B. Microcytosis, hypochromia, and pencil-shaped cells
C. Spherocytes and polychromasia
D. Schistocytes and nucleated red blood cells
386. Which of the following is a hallmark finding in iron deficiency anemia?
A. Reticulocytosis
B. Elevated haptoglobin levels
C. Decreased reticulocyte production index
D. High serum ferritin levels
387. A possible long-term complication of untreated severe iron deficiency anemia is:
A. Myocardial infarction
B. Heart failure
C. Polycythemia
D. Bone marrow fibrosis
388. Plummer-Vinson syndrome, associated with severe iron deficiency, includes:
A. Splenomegaly and hepatomegaly
B. Dysphagia and esophageal webs
 C. Hemoglobinuria and kidney failure
D. Pancytopenia and bone marrow failure
389. In IDA, iron absorption occurs predominantly in the:
A. Stomach
B. Duodenum and proximal jejunum
C. Ileum
D. Colon
390. The storage form of iron in the body is:
A. Transferrin
B. Hemoglobin
C. Ferritin
D. Hemosiderin
391. Which of the following proteins is responsible for transporting iron in the bloodstream?
A. Albumin
B. Transferrin
C. Haptoglobin
D. Ferritin
392. A sign of chronic IDA that involves spoon-shaped nails is known as:
A. Leukonychia
B. Koilonychia
C. Onycholysis
D. Beau’s lines
393. Which lab value differentiates IDA from anemia of chronic disease (ACD)?
A. Serum iron
B. Total iron-binding capacity (TIBC)
C. Mean corpuscular volume (MCV)
D. Hemoglobin level
394. Anemia with a low MCV and low reticulocyte count suggests:
A. Iron deficiency anemia
B. Hemolytic anemia
C. Megaloblastic anemia
D. Sickle cell anemia
395. The best dietary source of heme iron is:
A. Spinach
B. Red meat
C. Lentils
D. Fortified cereals
396. Iron absorption is inhibited by:
A. Orange juice
B. Tea or coffee
C. Vitamin C
D. Low gastric Ph
397. Iron is stored in macrophages in the form of:
A. Transferrin
B. Ferritin and hemosiderin
C. Hemoglobin
D. Myoglobin
398. In IDA, which enzyme activity is reduced due to low heme availability
A. Superoxide dismutase
B. Cytochrome oxidase
C. Catalase
D. Glutathione reductase
399. In iron deficiency anemia, which of the following parameters is increased?
A. Serum ferritin
B. Reticulocyte hemoglobin content
C. Free erythrocyte protoporphyrin
D. Mean corpuscular volume (MCV)
400. Which is a potential adverse effect of oral iron therapy?
A. Hypokalemia
B. Dark stools
C. Hyperbilirubinemia
D. Bradycardia