PANCE PANCE Hematology 1 — Questions and Answers
Question 1: A patient has microcytic anemia, low serum ferritin, low serum iron, and elevated TIBC. What is the diagnosis?
- Iron deficiency anemia (Correct answer)
- Anemia of chronic disease
- Thalassemia minor
- Sideroblastic anemia
Correct answer: Iron deficiency anemia
Low ferritin, low serum iron, and elevated TIBC are the hallmark lab findings of iron deficiency anemia.
Question 2: A 70-year-old has macrocytic anemia, glossitis, and neurologic symptoms. Labs show elevated methylmalonic acid and homocysteine. What is the deficiency?
- Vitamin B12 (Correct answer)
- Folate
- Thiamine
- Pyridoxine
Correct answer: Vitamin B12
Elevated methylmalonic acid distinguishes B12 deficiency from folate deficiency, since only B12 is required in the MMA metabolic pathway.
Question 3: A 28-year-old African American male develops hemolytic anemia after starting primaquine for malaria prophylaxis. What is the underlying enzyme deficiency?
- G6PD deficiency (Correct answer)
- Pyruvate kinase deficiency
- Hereditary spherocytosis
- Methemoglobin reductase deficiency
Correct answer: G6PD deficiency
G6PD deficiency causes episodic hemolysis triggered by oxidative stressors like primaquine, dapsone, or fava beans.
Question 4: A patient with sickle cell disease presents with acute bone pain, fever, and dactylitis. What is the most appropriate initial management?
- IV fluids, oxygen, and analgesics (Correct answer)
- Emergent exchange transfusion
- Hydroxyurea initiation
- Bone marrow transplant referral
Correct answer: IV fluids, oxygen, and analgesics
Acute vaso-occlusive crisis is managed with IV hydration, supplemental oxygen, and adequate analgesia.
Question 5: A patient with CKD has normocytic anemia and a reticulocyte count of 0.5%. What is the most likely pathophysiologic cause?
- Decreased erythropoietin production (Correct answer)
- Iron deficiency
- Vitamin B12 deficiency
- Hemolysis
Correct answer: Decreased erythropoietin production
CKD causes anemia primarily through decreased renal erythropoietin production, leading to inadequate red cell stimulation.
Question 6: A patient has petechiae, mucosal bleeding, and a platelet count of 8,000. PT and aPTT are normal. What is the most likely diagnosis?
- Immune thrombocytopenic purpura (Correct answer)
- DIC
- Thrombotic thrombocytopenic purpura
- Bernard-Soulier syndrome
Correct answer: Immune thrombocytopenic purpura
ITP presents with isolated thrombocytopenia and normal coagulation studies, caused by autoantibodies against platelet glycoproteins.
PANCE PANCE Hematology 1
A patient has microcytic anemia, low serum ferritin, low serum iron, and elevated TIBC.
What is the diagnosis?