Iron deficiency anaemia

Iron deficiency anaemia

Q. 1 Which of the following defines relation between quality assurance (QA), quality control (QC), internal quality assurance (lQA) & external quality assurance (EQA)
 A QA = QC + IQA + EQA
 B QC = QA + IQA – EQA
 C QC = QA + IQA + EQA
 D QA = QC + IQA – EQA
Q. 1 Which of the following defines relation between quality assurance (QA), quality control (QC), internal quality assurance (lQA) & external quality assurance (EQA)
 A QA = QC + IQA + EQA
 B QC = QA + IQA – EQA
 C QC = QA + IQA + EQA
 D QA = QC + IQA – EQA
Ans. A

Explanation:

QUALITY ASSURANCE: (QA) A programme designed to monitor and evaluate the ongoing and overall quality of the total testing process, including preanalytical analytical and post analytical phases of testing

QUALITY CONTROL: (QC) A process in the laboratory designed to monitor the analytical phase of testing procedure to ensure that the tests are working properly


Q. 2

A 17 year old female with iron deficiency anemia remains anemic despite treatment with oral iron preparation. Which of the following statements about iron metabolism is CORRECT?

 A

Iron is more efficiently absorbed in the ferrous state than in the ferric state

 B

The gastrointestinal rate of iron absorption is extremely high

 C

Most iron in the body is stored as hemosiderin

 D

Hemosiderin is a product of hemoglobin degradation

Q. 2

A 17 year old female with iron deficiency anemia remains anemic despite treatment with oral iron preparation. Which of the following statements about iron metabolism is CORRECT?

 A

Iron is more efficiently absorbed in the ferrous state than in the ferric state

 B

The gastrointestinal rate of iron absorption is extremely high

 C

Most iron in the body is stored as hemosiderin

 D

Hemosiderin is a product of hemoglobin degradation

Ans. A

Explanation:

The absorption of nonheme iron in any food is strongly affected by the composition of the meals.
Iron is more efficiently absorbed in the ferrous state than in the ferric state and commercial iron preparations often contain vitamin C to prevent oxidation of ferrous to ferric iron.
Still only 3 to 6 percent of the adjusted daily iron is actually absorbed in the upper gastrointestinal tract.
Seventy percent of the total body iron is used for hemoglobin and myoglobin; the remainder is stored as readily exchangeable ferritin, and some is stored in less easily mobilized hemosiderin.
When old red blood cells are destroyed by the tissue macrophage system, heme is separated from globin and degraded to biliverdin.
Iron in the plasma is bound to the iron transporting protein transferrin.
Transferrin level (total iron binding capacity) and saturation are clinically important indicators of iron deficiency anemia.
 
Ref: Kaushansky K., Kipps T.J. (2011). Chapter 37. Hematopoietic Agents: Growth Factors, Minerals, and Vitamins. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12e.

Q. 3

You suspect iron deficiency anemia in a 46 year old lady presenting with pallor. Which blood investigation result is NOT consistent with your provisional diagnosis?

 A

Low levels of plasma ferritin

 B

Decreased saturation of transferrin

 C

Decreased level of hemoglobin

 D

Decreased level of red cell protoporphyri

Q. 3

You suspect iron deficiency anemia in a 46 year old lady presenting with pallor. Which blood investigation result is NOT consistent with your provisional diagnosis?

 A

Low levels of plasma ferritin

 B

Decreased saturation of transferrin

 C

Decreased level of hemoglobin

 D

Decreased level of red cell protoporphyri

Ans. D

Explanation:

Protoporphyrin is an intermediate in the pathway to heme synthesis. Under conditions in which heme synthesis is impaired, protoporphyrin accumulates within the red cell. Normal values are

The most common causes of increased red cell protoporphyrin levels are absolute or relative iron deficiency and lead poisoning.
 
Under steady-state conditions, the serum ferritin level correlates with total body iron stores; thus, the serum ferritin level is the most convenient laboratory test to estimate iron stores. 
 
The TIBC (Total Iron Binding Capacity) is an indirect measure of the circulating transferrin. The normal range for the serum iron is 50–150 g/dL; the normal range for TIBC is 300–360 g/dL. Transferrin saturation, which is normally 25–50%, is obtained by the following formula: serum iron x 100 ÷ TIBC. Iron-deficiency states are associated with saturation levels below 20%. 
 
Ref: Adamson J.W. (2012). Chapter 103. Iron Deficiency and Other Hypoproliferative Anemias. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

Quiz In Between


Q. 4

Which of the following findings is diagnostic of iron deficiency anemia?

 A

Increased TIBC, decreased serum ferritin

 B

Decreased TIBC, decreased serum ferritin

 C

Increased TIBC, increased serum ferritin

 D

Decreased TIBC, increased serum ferritin

Q. 4

Which of the following findings is diagnostic of iron deficiency anemia?

 A

Increased TIBC, decreased serum ferritin

 B

Decreased TIBC, decreased serum ferritin

 C

Increased TIBC, increased serum ferritin

 D

Decreased TIBC, increased serum ferritin

Ans. A

Explanation:

Iron deficiency anemia is associated with increased Total iron binding capacity (TIBC) and decreased ferritin.

Ref: Harrison’s Principles of Internal Medicine, 17th Edition, Page 631, 663; Davidson’s principles and practice of Medicine, 20th Edition, Chapter 24, Page 1025-1027 &1030


Q. 5

True about iron deficiency anemia is/are –

 A

Howel jolly bodies

 B

Anisocytosis

 C

Polychromasia

 D

All

Q. 5

True about iron deficiency anemia is/are –

 A

Howel jolly bodies

 B

Anisocytosis

 C

Polychromasia

 D

All

Ans. B

Explanation:

Ans. is `b’ i.e., Anisocytosis

Anisocytosis, hypochromia and poikilocytosis are seen in iron deficiency anemia.

o MCV (normal — 82 to 96 IL) is decreased in iron deficiency anemia (60-90 fL)

o Howell-Jolly bodies are seen in megaloblastic anema, after splenectomy and in hemolytic anemia (not in iron deficiency anemia)

I think option ‘c’ requires specific mention here:

Polychromasia

o Polychromasia refers to variation in erythrocyte coloration.

o Normally younger (immature) erythrocytes stain blue with Romanowsky stain, whereas mature erythrocytes stain uniformly orange-pink.

o A slight degree of polychromasia is normal i.e. some degree of variation in colour may occur normally.

o When immature erythrocytes are released into circulation (from bone marrow) there is significant variation in color of erythrocytes —> Polychromasia.

  • So, variation in color (polychromasia) largely relates to the maturation of cells.

o Polychromasia is seen when erythrocytes are released prematurely e.g. in response to erothropoietin or architectural damage to bone marrow (fibrosis, infiltration of bone marrow by malignant cells etc.)


Q. 6

In contrast to iron deficiency anemia in anemia of chronic disease, TIBC –

 A

Decreases

 B

Increases

 C

Normal

 D

None

Q. 6

In contrast to iron deficiency anemia in anemia of chronic disease, TIBC –

 A

Decreases

 B

Increases

 C

Normal

 D

None

Ans. A

Explanation:

Ans. is ‘a’ i.e., Decreases

Parameter Iron deficiency  Chronic disease

  • Serum iron Decreased Normal to decreased
  • Serum ferritin  Decreased  Normal to increased

o TIBC  Increased Decreased

o % Saturation Decreased  Normal to increased

o Bone marrow iron receptor  Decreased Normal to increased

o Serum transferrin receptor Increased Decreased

  • Pattern of anemia  Microcytosis preceedes  Hypochromia preceeds

hypochromia   microcytosis

Quiz In Between


Q. 7

First indices to change in iron deficiency anemia is –

 A

S. iron

 B

Total iron binding capacity

 C

S. ferritin

 D

S. haemoglobin concentration

Q. 7

First indices to change in iron deficiency anemia is –

 A

S. iron

 B

Total iron binding capacity

 C

S. ferritin

 D

S. haemoglobin concentration

Ans. C

Explanation:

Ans. is ‘c’ i.e., Serum Ferritin

  • During an Iron deficient state, the body will mobilize its Iron Stores & so try to maintain a near normal supply of Iron to tissues e.g. Bone Marrow.
  • So the first organ to be depleted of Iron wilt be the Iron stores.

o And we know Serum Ferritin reflects the body stores of Iron.

o Therefore serum ferritin is the first to be changed (i.e. depleted).


Q. 8

Elemental iron supplementation in Iron deficiency anemia is –

 A

300 -400 mg

 B

150 -200 mg

 C

100 – 150 mg

 D

mg

Q. 8

Elemental iron supplementation in Iron deficiency anemia is –

 A

300 -400 mg

 B

150 -200 mg

 C

100 – 150 mg

 D

mg

Ans. C

Explanation:

Ans. is ‘c’ i.e., 100 – 150 mg 


Q. 9

In Iron deficiency anemia, after haemoglobin level has returned to normal so that iron stores are replenished. The Iron tablets should be recommended for-

 A

0 – 3 months

 B

3 – 6 months

 C

6 – 12 months

 D

12 – 24 months

Q. 9

In Iron deficiency anemia, after haemoglobin level has returned to normal so that iron stores are replenished. The Iron tablets should be recommended for-

 A

0 – 3 months

 B

3 – 6 months

 C

6 – 12 months

 D

12 – 24 months

Ans. A

Explanation:

Ans. is ‘a’ i.e., 0-3 months 

Quiz In Between


Q. 10

Anemia of Chronic disease can be differentiated from Iron deficiency anemia by:

 A

↑ TIBC

 B

↓ TIBC

 C

↑ S.ferritn

 D

b and c

Q. 10

Anemia of Chronic disease can be differentiated from Iron deficiency anemia by:

 A

↑ TIBC

 B

↓ TIBC

 C

↑ S.ferritn

 D

b and c

Ans. D

Explanation:

Answer is B &  C  (↓TIBC;↑Ferritin)

Anemia of chronic disease is associated with decreased TIBC and increased serum Ferritin while Iron deficiency anemia is associated with Increased TIBC and reduced serum Ferritin

Differential diagnosis of Microcytic Hypochromic Anemia

 

Parameters

Iron deficiency

Chronic Inflammatory

Smear

Microcytic hypochromic + target cell

Normocytic Normochromic

> Microcytic Hypochromic

Se Fe

< 30 (4)

4(<50) 50)

TIBC

> 360 (i)

i (< 300)

Saturation

< 10 (4)

4- ( l 0-20)

Ferritin

< 15 (1-)

T (30-200)

Free Erythrocyte

Protporphrin

ted

ted


Q. 11

Which of the following is the first symptom of iron deficiency anemia?   

September 2010

 A

Low iron concentration in blood

 B

Reduced hemoglobin

 C

Reduced PCV

 D

Reduced ferritin

Q. 11

Which of the following is the first symptom of iron deficiency anemia?   

September 2010

 A

Low iron concentration in blood

 B

Reduced hemoglobin

 C

Reduced PCV

 D

Reduced ferritin

Ans. D

Explanation:

Ans. D: Reduced ferritin


Q. 12

Best test to detect iron deficiency anemia in a community with low prevalence of iron deficiency is:

March 2013

 A

PCV

 B

Iron binding capacity

 C

Serum Iron

 D

Serum ferritin

Q. 12

Best test to detect iron deficiency anemia in a community with low prevalence of iron deficiency is:

March 2013

 A

PCV

 B

Iron binding capacity

 C

Serum Iron

 D

Serum ferritin

Ans. D

Explanation:

Ans. D i.e. Serum ferritin

In the appropriate clinical setting, a smear showing hypochromia and microcytosis is adequate for the diagnosis.

When more specific tests are needed, a positive diagnosis can be made from low levels of ferritin, and a low serum iron level in association with an elevated total iron binding capacity.

Iron deficiency anemia (IDA):

  • Commonest cause of anemia in India
  • Increased iron absorption is seen in: Iron deficiency anemia, pregnancy, hypoxia, acidic pH of stomach, ferrous iron salts
  • Causes of IDA: Hookworms, celiac sprue, carcinoma colon
  • Features diagnostic of IDA: Decreased serum ferritin, increased TIBC
  • Earliest sign of IDA: Decrease in serum ferritin
  • Most sensitive and specific test for diagnosing IDA: Serum ferritin levels
  • Hypochromia may be preceded by microcytosis

Quiz In Between


Q. 13

Pattern in peripheral smear in iron deficiency anemia ‑

 A

Normocytic normochromic

 B

Hypochromic normocytic

 C

Hypochromic microcytic

 D

Normochromic microcytic

Q. 13

Pattern in peripheral smear in iron deficiency anemia ‑

 A

Normocytic normochromic

 B

Hypochromic normocytic

 C

Hypochromic microcytic

 D

Normochromic microcytic

Ans. C

Explanation:

Ans. is ‘c’ i.e., Hypochromic microcytic


Q. 14

Which of the following statements about iron deficiency anemia is correct

 A

Decreased TIBC

 B

Increased ferritin levels

 C

Bone marrow iron is decreased after serum iron is decreased

 D

Bone marrow iron is decreased earlier than serum iron

Q. 14

Which of the following statements about iron deficiency anemia is correct

 A

Decreased TIBC

 B

Increased ferritin levels

 C

Bone marrow iron is decreased after serum iron is decreased

 D

Bone marrow iron is decreased earlier than serum iron

Ans. D

Explanation:

Ans. is ‘D’ i.e., Bone marrow iron is decreased earlier than serum iron

In iron deficiency anemia the first change is decrease in iron stores “

The decrease in iron stores is demonstrated by decreased serum ferritin level.

Remember,

Serum ferritin reflects the amount of storage iron in the body.

As the total body iron level begins to fall a characteristic, sequence of events ensue :

  • First Stage or Prelatent Stage of Iron Depletion
  • When iron loss exceeds absorption, a negative iron balance exists.
  • Stored iron begins to be, mobilized from stores. The iron present in the macrophages of liver, spleen and bone marrow are depleted
  • Decrease in stored iron is reflected by decrease in serum ferritin.
  • At this stage all other parameters of iron status are normal.

Second Stage or Stage of Latent Iron Deficiency :

  • Iron stores are exhausted but the blood hemoglobin level remains higher than the lower limit of normal. o After the exhaustion of iron stores :
  • The plasma iron concentration fallsQ.
  • Plasma iron binding capacity increases2.
  • Percentage saturation falls below 15%Q.
  • The percentage of sideroblast decreases in the bone marrowQ.

Third Stage or Stage of Apparent Iron Deficiency Anemia

  • Supply of iron to marrow becomes inadequate for normal hemoglobin production,
  • So the blood hemoglobin concentration fallsQ below the lower limit of normal and iron deficiency anemia is apparent.

Q. 15

Response to iron in iron deficiency anemia is denoted by‑

 A

Restoration of enzymes

 B

Reticulocytosis

 C

Increase in iron binding capacity

 D

Increase in hemoglobin

Q. 15

Response to iron in iron deficiency anemia is denoted by‑

 A

Restoration of enzymes

 B

Reticulocytosis

 C

Increase in iron binding capacity

 D

Increase in hemoglobin

Ans. B

Explanation:

Ans. is ‘b’ i.e., Reticulocytosis 

Response to iron therapy

  • When specific iron therapy is given, patients often show rapid subjective improvement, with disappearance or marked diminution of fatigue, lassitude, and other non-specific symptoms. This response may occur before any improvment in anemia is observed.
  • The earliest hematological evidence of recovery is increase reticulocytes and their hemoglobin content. The reticulocytes attain a maximal value on the 5th to 10th day after institution of therapy and thereafter gradually return to nonnal. The reticulocyte response may not be detectable in mild iron deficiency anemia.
  • The blood hemoglobin level is the most accurate measure of the degree of anemia in iron deficiency anemia. During the response to therapy, the red cell count may increase temporarily to values above normal, but the hemoglobin value lags behind.
  • The red cell indices may remain abnormal for some time after the normal hemoglobin level is restored. As recovery occurs, a normocytic cell population gradually replaces the microcytic population; and one of the early signs of response to therapy is an increase in RBW from pretreatment level.
  • When treatment is fully effective, hemoglobin reaches normal levels by 2 months after therapy is initiated, regard­less of starting values.
  • Of the epithelial lesions in iron deficiency, those affecting the tongue and nails are the most responsive to treatment.

Quiz In Between



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