PA H3 | Microcytic Anemias — Practice Quiz

Iron absorbed in the duodenum as Fe²⁺ enters the enterocyte via DMT1. Which protein then exports iron from the basolateral surface of the enterocyte into the portal circulation?

A 28-year-old woman with rheumatoid arthritis (RA) develops worsening fatigue. Labs: Hb 9.2 g/dL, MCV 74 fL, serum iron 42 µg/dL, TIBC 180 µg/dL (low; normal 250-370), ferritin 310 ng/mL (elevated), transferrin saturation 23%. Which mechanism best explains why her TIBC is LOW rather than HIGH as in iron deficiency anaemia?

A 35-year-old woman presents with fatigue. Serial blood tests over 6 months show the following progression: | Time | Ferritin (ng/mL) | Serum Iron (µg/dL) | TIBC | Hb (g/dL) | MCV (fL) | |------|------------------|--------------------|------|-----------|----------| | 0 mo | 9 (↓) | 90 | 360 | 13.2 | 85 | | 3 mo | 5 (↓) | 65 | 390 | 12.6 | 80 | | 6 mo | 4 (↓) | 40 | 430 | 10.1 | 68 | Which is the FIRST haematological parameter to become abnormal in sequential iron depletion?

A 45-year-old man has serum iron = 55 µg/dL and TIBC = 440 µg/dL. Calculate his transferrin saturation and classify his iron status.

A 55-year-old man with a 3-month history of increasing fatigue presents with Hb 9.8 g/dL, MCV 72 fL, ferritin 6 ng/mL, TIBC 480 µg/dL, transferrin saturation 8%. He has no history of vegetarianism, blood donation, or menorrhagia. Which is the MOST IMPORTANT next investigation?

A 30-year-old woman with heavy menstrual periods has Hb 10.2 g/dL, MCV 70 fL, ferritin 5 ng/mL, TIBC 460 µg/dL. Her CRP is 45 mg/L (elevated) due to a recent urinary tract infection. A colleague argues the ferritin may be falsely normal because of co-existing inflammation. Which test MOST accurately reflects true iron store status when ferritin is elevated by acute-phase response?

A 42-year-old woman with longstanding IDA complains of progressive difficulty swallowing solids for 3 months. She can swallow liquids normally. Endoscopy reveals a mucosal web in the upper oesophagus. What is the MOST IMPORTANT reason to treat her IDA aggressively?

A 10-year-old Punjabi boy is found to have Hb 11.4 g/dL and MCV 62 fL at a school health check. His parents are asymptomatic but both show similar microcytosis. Serum ferritin = 38 ng/mL (normal), iron studies normal. Mentzer Index = MCV ÷ RBC. His RBC count is 5.9 × 10¹²/L. Calculate the Mentzer Index and interpret it.

A 24-year-old Sindhi woman presents for pre-marital counselling. Her CBC shows Hb 12.1 g/dL, MCV 66 fL, RBC 5.7 × 10¹²/L, ferritin 42 ng/mL. HPLC shows HbA₂ = 4.8% (elevated; normal < 3.5%). Her fiancé's HPLC shows HbA₂ = 5.1%. What is the MOST important genetic counselling point for this couple?

A 68-year-old woman with chronic kidney disease (CKD stage 4) has Hb 9.6 g/dL, MCV 76 fL, serum iron 38 µg/dL, TIBC 165 µg/dL (low), ferritin 280 ng/mL (elevated). Her nephrologist notes her anaemia is not fully explained by erythropoietin deficiency alone. Which additional mechanism drives anaemia in CKD via the iron-regulatory axis?

A 38-year-old man presents with gradually worsening weakness and occasional abdominal discomfort. He works as a battery recycler. CBC: Hb 10.8 g/dL, MCV 72 fL, RDW 19% (elevated). Peripheral smear shows two populations of red cells — one normocytic normochromic, one small and pale — along with coarse BASOPHILIC STIPPLING. Serum ferritin is 380 ng/mL and transferrin saturation is 62%. What is the MOST LIKELY diagnosis?

You are reviewing a peripheral blood smear from a patient with Hb 8.4 g/dL, MCV 65 fL. The smear description reads: 'Numerous elongated, pencil-shaped (cigar-shaped) red cells with central pallor > 1/3 diameter, frequent hypochromic microcytes, and occasional target cells. No basophilic stippling. No nucleated RBCs.' Which ONE condition does this smear pattern MOST support?

A bone marrow aspirate smear from a patient with microcytic anaemia is stained with Perls' Prussian blue stain. Examination reveals erythroblasts with blue-staining iron granules arranged in a RING around the nucleus, occupying ≥ 1/3 of the nuclear circumference, present in > 15% of erythroblasts. What is this finding called, and what is the MOST LIKELY underlying diagnosis?

A peripheral blood smear from a patient with Hb 9.8 g/dL, MCV 68 fL shows the following features: numerous target cells (codocytes) with a bulls-eye appearance, mild anisopoikilocytosis, occasional hypochromic cells, and some cells showing punctate basophilic stippling. The RBC count is 5.4 × 10¹²/L (elevated for the degree of anaemia). Serum ferritin = 45 ng/mL (normal). HPLC shows HbA₂ = 5.2%. Which smear pattern finding is MOST characteristic of this condition and also distinguishes it from IDA?