PA13.{2,4} | Approach to Anemia & Lab Investigation — Graded Quiz

A 28-year-old woman who is 30 weeks pregnant presents with breathlessness on minimal exertion. Her CBC shows: Hb 9.1 g/dL, MCV 85 fL (normal), WBC and platelets normal. Peripheral smear: normocytic normochromic cells. Her serum ferritin is 8 ng/mL and transferrin saturation is 12%. The most likely explanation for the NORMAL MCV in this context is:

A 45-year-old male farmer from Karnataka presents with progressive fatigue, pallor, and a 10 kg weight loss over 6 months. His CBC: Hb 7.9 g/dL, MCV 68 fL, RDW 19.2%. He is not vegetarian and has no history of blood donation. Applying the 5-step anaemia workup, which investigation is MOST CRITICAL at Step 5 (identify the underlying cause)?

A 60-year-old woman with rheumatoid arthritis on methotrexate presents with worsening anaemia. CBC: Hb 9.6 g/dL, MCV 92 fL, reticulocyte count 0.8%. Serum iron is 38 µg/dL, TIBC is 170 µg/dL (low-normal), ferritin is 420 ng/mL. C-reactive protein is elevated. The reticulocyte production index is 0.7. Which anaemia classification BEST fits this patient?

A technician performs a differential leucocyte count on a peripheral blood smear from a febrile patient. After counting 100 cells, the report shows: neutrophils 88%, lymphocytes 8%, monocytes 4%. However, the cells were counted only in the feather edge/tail of the smear. Which error has occurred and what is the EXPECTED impact on the differential?

A haematology laboratory is processing a sample from a 72-year-old man on warfarin. The automated analyser reports a haemoglobin of 14.2 g/dL, but the cuvette appears visibly turbid/milky. The technician notices the patient has a serum triglyceride of 28 mmol/L (severe lipaemia). What is the MOST appropriate corrective action?

A 19-year-old college student presents with pallor, fatigue, and angular stomatitis. Her CBC: Hb 8.6 g/dL, MCV 66 fL, MCH 20 pg, MCHC 26 g/dL, RDW 20.8%, platelets 540 × 10⁹/L. Reticulocyte count is 1.1%. Applying the etiological classification framework, the reticulocyte production index (RPI) confirms which type of anaemia?

A 4-year-old girl from a tribal district in Odisha presents with pallor, irritability, and developmental delay. Her Hb is 6.2 g/dL. The treating physician prescribes oral iron as ferrous sulphate. On follow-up at 4 weeks, haemoglobin has risen to only 7.0 g/dL (expected rise >1 g/dL/week). Which of the following is the MOST LIKELY reason for the suboptimal response?

A Neubauer haemocytometer is loaded with blood diluted 1:20 in Turk's fluid. The technician counts WBCs in all four large corner squares. Total cells counted = 60. What is the WBC count per mm³, and what is the most likely clinical interpretation if this patient is a 25-year-old with fever?

A laboratory running daily quality control (QC) for a haematology analyser plots the WBC count for three levels of QC material over 20 days. The low-control WBC values are consistently within ±2 SD but show a progressive downward drift over the 20 days (a 'trend'). The normal and high controls remain stable. Which of the following is the MOST LIKELY explanation?

A 5-year-old child weighing 16 kg presents with severe aplastic anaemia (Hb 4.1 g/dL, neutrophils 0.3 × 10⁹/L, platelets 18 × 10⁹/L). A bone marrow aspirate is performed. The cytology shows hypocellular marrow with predominantly fat cells and rare haemopoietic precursors. Based on this morphology, the anaemia is BEST classified as:

A 35-year-old woman with suspected immune thrombocytopenic purpura (ITP) has an automated platelet count of 32,000/mm³. The haematologist requests a peripheral smear review. The smear shows normal-sized platelets without clumping, and the platelet estimate from the smear correlates with the automated count. A repeat CBC on a citrate tube (for pseudothrombocytopenia exclusion) shows platelets of 34,000/mm³. What is the MOST appropriate interpretation?

A technician preparing a peripheral blood smear for a DLC counts 200 cells in a zigzag (battlement) pattern across the monolayer zone. The report shows: neutrophils 72%, lymphocytes 18%, monocytes 6%, eosinophils 4%, basophils 0%. However, the adjacent pathologist reviews the same smear and finds that neutrophils are 62% and lymphocytes are 24%. Which is the MOST LIKELY explanation for the discrepancy?