Anaemia
Hypoproliferative anaemia is characterised by a reticulocyte count of less than 2.5%
What our notes say
- Hypoproliferative anaemia is characterised by a reticulocyte count of less than 2.5% (Internal Medicine End of Semester CAT (MBChB 4): haematology and renal, 30 MCQs )
- Plasma rises by about 40 to 50% and red cell mass by about 20 to 30%, so the dilution produces physiological anaemia. (Reproductive Health 1 End of Trimester CAT: 40 MCQs and 4 short answers)
- Detects and treats conditions such as anaemia, hypertension, malaria, syphilis and HIV early. (Reproductive Health 1 End of Trimester CAT: November 2018)
- Early detection and treatment of complications such as anaemia, hypertension and infection (Reproductive Health 1 End of Trimester CAT: ectopic pregnancy, ANC and abortion )
- Plasma volume rises by 40 to 50% and red cell mass by 20 to 30%, causing physiological (dilutional) anaemia. (Reproductive Health 1 End of Trimester CAT: ectopic pregnancy, ANC and abortion )
- Symptom control: NSAIDs and tranexamic acid for heavy bleeding, and iron for anaemia. (Year 4 Gynaecology CAT (MBOG 4212): 13 December 2019)
Study material on Anaemia
- Haematology Exam 2025: MCQs on Anaemia, Leukaemia & Clotting
- Haematology Revision: Haematopoiesis, Anaemia & IDA Guide
- Approach to anaemia
- Haematology End of Year 2025 Past Paper — MKU MBML 3200 Questions & Answers
- Aplastic Anemia: Causes, Symptoms & Treatment | Hematology
- Hematopathology MCQs & Essays: MBChB Exam Revision Guide
- Internal Medicine End of Semester CAT (MBChB 4): haematology and renal, 30 MCQs and 3 short answers
- Internal Medicine (MBIM 4100) special/supplementary exam, Paper Two: 14 August 2019
- HEMATOLOGY EOY 2025
- Haematopathology MCQs: Blood Disorders & Anemia Explained
- Haematology Exam 2025: MCQs on Anaemia, Leukaemia & Clotting
- MCQ: High-Yield MCQs — Haematology (All Topics)
- MCQ: Here are the full MCQs with answers and explanations:
- Haematopathology MCQs: Blood Disorders, Lymphoma & Anemia
Practice questions on Anaemia
A 68-year-old woman is found to have 2.1 g/dL of monoclonal IgG in her serum on a routine check. She has no bone pain, no anaemia, no Bence Jones proteinuria, and bone marrow shows 8% plasma cells. She is asymptomatic. What is the risk of this condition progressing to symptomatic myeloma?
- It will never progress as plasma cells are below 10%
- It progresses at approximately 1% per year and contains the same chromosomal translocations as myeloma
- It progresses rapidly within 1–2 years in all patients
- It only progresses if the M protein exceeds 3 g/dL
Answer: B. This is MGUS — the most common plasma cell proliferation, found in 1–3% of healthy persons over 50. Despite its name, MGUS is a precursor lesion that progresses to symptomatic plasma cell tumour at approximately 1% per year. The clonal plasma cells in MGUS already contain the same chromosomal translocations as full-blown myeloma. Diagnosis of MGUS requires less than 3 g/dL monoclonal protein and no Bence Jones protei
A 65-year-old man presents with massive splenomegaly and anaemia. Peripheral blood smear shows teardrop cells, nucleated red cells, and immature myeloid cells. Bone marrow trephine is hypocellular and fibrotic. Which of the following BEST explains the origin of the marrow fibrosis?
- Neoplastic fibroblasts proliferating as part of the malignant clone
- TGF-β and PDGF released from neoplastic megakaryocytes stimulating non-neoplastic fibroblasts
- BCR-ABL signalling directly activating fibroblast growth factor receptors
- IL-6 secreted by myeloma cells stimulating collagen deposition
Answer: B. This is primary myelofibrosis — teardrop cells, leukoerythroblastosis, and fibrotic marrow. A critical concept is that the fibroblasts are NOT part of the neoplastic clone. The fibrosis is secondary — stimulated by PDGF and TGF-β released from neoplastic megakaryocytes. BCR-ABL is the driver in CML, not primary myelofibrosis. IL-6 drives myeloma cell proliferation and bone resorption, not marrow fibrosis. ---
A patient presents with recurrent infections, petechiae, and anaemia. A bone marrow biopsy shows reduced cellularity. What is the most likely diagnosis?
- Aplastic anaemia
- Iron deficiency anaemia
- Polycythaemia vera
- Thalassaemia
Answer: A. The triad of infections (low WBC), petechiae (low platelets), and anaemia (low RBC) reflects pancytopenia; combined with a hypocellular marrow, this is diagnostic of aplastic anaemia — failure of the marrow to produce blood cells of all lineages. ---
The MCV in iron deficiency anaemia is
- Normal
- Elevated
- Low
- Variable depending on severity
Answer: C. Low MCV (microcytic anaemia) occurs because insufficient iron limits haemoglobin synthesis, reducing RBC size. ---
Which iron study pattern is seen in anaemia of chronic disease?
- Low ferritin, low serum iron, high TIBC
- High ferritin, low serum iron, low TIBC
- High ferritin, high serum iron, low TIBC
- Low ferritin, high serum iron, high TIBC
Answer: B. Inflammation sequesters iron in macrophages (high ferritin as acute phase reactant), reduces serum iron, and decreases TIBC — distinguishing it from iron deficiency. ---
The most common cause of macrocytic anaemia in the developed world is
- Folate deficiency
- B12 deficiency
- Alcohol excess
- Hypothyroidism
Answer: C. Alcohol causes macrocytosis through direct toxic effects on the bone marrow and poor nutrition; it is the most common cause overall in many populations. ---