ANEMIA IN PREGNANCY : MCQS AND IMPORTANT MCQS By DR MARIA RAFI
1. A 30-year-old pregnant female is undergoing routine blood tests. Pregnancy is associated with an increase in which of the following?
- A) Mean Cell Hemoglobin Concentration (MCHC)
- B) Serum ferritin concentration
- C) Hematocrit
- D) Total Iron Binding Capacity (TIBC) ✅
Answer: D) Total Iron Binding Capacity (TIBC)
Explanation:
- Pregnancy leads to increased TIBC due to higher transferrin synthesis to compensate for increased iron demand.
- Serum ferritin and iron decrease due to increased iron utilization.
- Hematocrit reduces due to physiological hemodilution, not an actual decrease in RBC mass.
2. A 28-year-old female, para 2+0, presents with Hb 7 g/dL. What is the next best investigation?
- A) Hb electrophoresis
- B) Total iron-binding capacity (TIBC)
- C) MCV and peripheral smear✅
- D) Serum iron
Answer: A) Hb electrophoresis
Explanation:
The first step is to check MCV (Mean Corpuscular Volume) to classify anemia.
- A peripheral smear helps identify abnormal red blood cell morphology, which can indicate hemolysis, iron deficiency, or megaloblastic anemia.
- If MCV is low and ferritin is normal, Hb electrophoresis is needed to rule out thalassemia.
- Serum iron and TIBC are useful in evaluating iron metabolism but do not confirm the type of microcytic anemia.
3. A 28-year-old female, para 2+0, presents with Hb 7 g/dL, MCV decreased, and MCHC normal. What is the next best investigation?
- A) Hb electrophoresis ✅
- B) Total iron-binding capacity (TIBC)
- C) Vitamin B12 level
- D) Serum iron
Answer: A) Hb electrophoresis
Explanation:
- Microcytic anemia (low MCV, normal MCHC) is suggestive of thalassemia.
- If ferritin levels are low, IDA is likely, but if normal, thalassemia should be suspected.
- Hb electrophoresis is the definitive test for diagnosing thalassemia
4. A 30-year-old male presents with shortness of breath, pallor, HB ;8G/DL MCV decreased, and MCHC low. What is the most appropriate diagnostic test?
- A) Complete blood count (CBC)
- B) Peripheral smear
- C) Hb electrophoresis
- D) Serum ferritin ✅
Answer: D) Serum ferritin
Explanation:
- Microcytic anemia with low MCV and low MCHC suggests iron deficiency anemia (IDA) or thalassemia.
- Serum ferritin is the best test to assess iron stores.
- If ferritin is low, IDA is confirmed. If ferritin is normal, further testing (Hb electrophoresis) is needed for thalassemia.
5. A 20-year-old primigravida at 20 weeks gestation presents with Hb 7 g/dL. What is the next best investigation to determine the cause of anemia?
- A) Serum iron
- B) Hb electrophoresis
- C) Serum folate
- D) MCV + Serum ferritin ✅
Answer: D) MCV + Serum ferritin
Explanation:
- HB THEN INDICES MEAN MCV ,MCH AND MCH AND THEN PERIPHERAL SMEAR . IF MCHC NORMAL GO FOR HB ELECTROPHORESIS ;IF MCHC LOW THEN SERUM FERRITIN.
- HERE BEST OPTION IF D
6. A 28-year-old multigravida at 30 weeks gestation presents with Hb 8.0 g/dL, fatigue, and palpitations. What is the most appropriate management?
- A) Packed cell transfusion
- B) Parenteral iron ✅
- C) Oral iron
- D) Whole blood transfusion
Answer: B) Parenteral iron
Explanation:
- 30 AND ONWARD WITH HB MORE THEN 7 CHOOSE IV IRON
7. Management of Anemia in a 28-Week Pregnant Woman with Hb 9 g/dL
A 32-year-old multigravida at 28 weeks gestation presents with Hb 9 g/dL, fatigue, and palpitations. What is the most appropriate management?
- A) Packed cell transfusion
- B) Parenteral iron
- C) Oral iron ✅
- D) Whole blood transfusion
Answer: C) Oral iron
Explanation:
- HB MORE THEN 7 AT <30 WEEKS CHOOSE ORAL IRON
8. A 30-year-old multigravida at 30 weeks gestation presents with Hb 6.0 g/dL, fatigue, and palpitations. What is the most appropriate management?
- A) Packed cell transfusion ✅
- B) Parenteral iron
- C) Oral iron
- D) Whole blood transfusion
Answer: A) Packed cell transfusion
Explanation:
- Severe anemia (Hb < 7 g/dL) in late pregnancy with symptoms requires immediate packed RBC
- Whole blood transfusion (D) is not routinely recommended for anemia unless massive hemorrhage occurs.
9.
A 32-year-old multigravida at 32 weeks gestation presents with antepartum hemorrhage (APH), pallor, hypotension, and tachycardia. What is the most appropriate initial management?
- A) Whole blood transfusion ✅
- B) Packed cell transfusion
- C) Intravenous iron therapy
- D) Oral iron supplementation
Answer: A) Whole blood transfusion
Explanation:
- Whole blood provides both RBCs and coagulation factors, making it superior in acute hemorrhage compared to packed RBC transfusion alone.
- Packed RBC transfusion (B) is used for chronic anemia, not acute blood loss requiring volume replacement.
10.
A 30-week pregnant woman with a history of valvular heart disease presents with pallor, dyspnea, and pedal edema. What is the most likely cause?
- A) Pulmonary Edema
- B) Cardiac Failure
- C) Anemia ✅
Answer: C) Anemia
Explanation:
- Pallor and dyspnea are key features of anemia, which leads to decreased oxygen-carrying capacity in pregnancy.
- Mild pedal edema in anemia may occur due to hypoalbuminemia and plasma volume expansion.
11.
A 30-week pregnant woman with a history of valvular heart disease presents with Pallor , dyspnea, orthopnea, and pedal edema. On examination, she has tachycardia, bp 90/80 mmgh nd raised JVP and basal crepitations.
What is the most likely diagnosis?
- A) Pulmonary Edema
- B) Anemia
- C) Cardiac Failure ✅
Answer: C) Cardiac Failure
Explanation:in cardiac failure thr r left nd right heart failure sign
- Dyspnea, orthopnea, and PND → Indicate left ventricular failure.
- Raised JVP and Pedal Edema → Suggest fluid overload and right heart strain.
- Basal Crepitations → Pulmonary congestion due to heart failure.
- Tachycardia & Cyanosis → Impaired cardiac output affecting oxygenation.
Why Not Other Options?
- A) Pulmonary Edema → Presents suddenly with frothy sputum, severe hypoxia, and acute respiratory distress.
- B) Anemia → Causes pallor, exertional dyspnea, and tachycardia but no orthopnea, PND, or lung crepitations.
12.
A 30-week pregnant woman with a known history of mitral stenosis presents to the emergency with sudden onset severe dyspnea, orthopnea, and cough with frothy pink sputum. On examination, her respiratory rate is 32/min, heart rate is 120/min, and oxygen saturation is 85% . Auscultation reveals bilateral basal crepitations
What is the most likely diagnosis?
- A) Cardiac Failure
- B) Pulmonary Edema ✅
- C) Anemia
Answer: B) Pulmonary Edema
Explanation: MITRAL STENOSIS IS RISK FACTOR AT 30WEEKS
- Sudden onset severe dyspnea → Suggests acute worsening of left heart function.
- Orthopnea + Frothy pink sputum → Classic signs of acute pulmonary edema.
- Bilateral basal crepitations → Indicate fluid accumulation in alveoli.
- Cyanosis, tachycardia, and respiratory distress → Suggest severe hypoxia requiring urgent intervention.
13:A 35-week pregnant woman with a history of postpartum hemorrhage (PPH) presents with breathlessness. What is the most likely cause of her shortness of breath (SOB)?
-
Options:
a) Microcytic anemia
b) Cardiac failure
c) Pulmonary edema
d) Pulmonary embolism
✅ Correct Answer: a) Microcytic anemia
Options:
a) Microcytic anemia
b) Cardiac failure
c) Pulmonary edema
d) Pulmonary embolism
✅ Correct Answer: a) Microcytic anemia
MCQ 14.A pregnant woman has the following blood parameters: Hb: 7 mg/dL, Hct: 31%, MCV: 60. fl, serum Iron: 20micro gram/dl , Ferritin: 10 µg/L.
-
What type of anemia does she likely have?
Options:
a) Macrocytic anemia
b) Microcytic anemia
c) Normocytic anemia
d) Hemolytic anemia
✅ Correct Answer: b) Microcytic anemia
Simplified Explanation:
- Low MCV (<80 fl) + low ferritin (<30 µg/L) = iron deficiency anemia.
- Iron deficiency anemia is the most common cause of microcytic anemia in pregnancy.
- Other types (macrocytic, normocytic, hemolytic) have different lab findings.
What type of anemia does she likely have?
Options:
a) Macrocytic anemia
b) Microcytic anemia
c) Normocytic anemia
d) Hemolytic anemia
✅ Correct Answer: b) Microcytic anemia
Simplified Explanation:
- Low MCV (<80 fl) + low ferritin (<30 µg/L) = iron deficiency anemia.
- Iron deficiency anemia is the most common cause of microcytic anemia in pregnancy.
- Other types (macrocytic, normocytic, hemolytic) have different lab findings.
MCQ:15 A patient underwent investigations, and the report shows HbA2 > 3.5%. What is the most likely diagnosis?
-
Options:
a) Alpha thalassemia
b) Beta thalassemia
c) Sickle cell anemia
d) Iron deficiency anemia
✅ Correct Answer: b) Beta thalassemia
Options:
a) Alpha thalassemia
b) Beta thalassemia
c) Sickle cell anemia
d) Iron deficiency anemia
✅ Correct Answer: b) Beta thalassemia
Simplified Explanation:
-
- HbA2 > 3.5% is a hallmark of beta-thalassemia trait (minor).
- Alpha thalassemia does not increase HbA2 levels.
- Sickle cell anemia and iron deficiency anemia do not show a raised HbA2.
- Beta thalassemia leads to decreased beta-globin production, causing a compensatory increase in HbA2 levels.
- HbA2 > 3.5% is a hallmark of beta-thalassemia trait (minor).
- Alpha thalassemia does not increase HbA2 levels.
- Sickle cell anemia and iron deficiency anemia do not show a raised HbA2.
- Beta thalassemia leads to decreased beta-globin production, causing a compensatory increase in HbA2 levels.
MCQ:16 What is the total average iron requirement during pregnancy?
Options:
a) 1350 mg
b) 1000 mg
c) 90 mg
d) 60 mg
✅ Correct Answer: c) 1350 mg
Simplified Explanation:
- The total iron requirement during pregnancy is approximately 1250 mg to support fetal growth, maternal blood expansion, and iron losses.
- near to that is 1350
- Iron req is 1250 mg is mcq
-
- Now Oral is first line , as guidline and books hv difference data so mostly used in pakistan before 30weeks we use oral iron
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😊SOGP
- First screening test for iron deficiency anaemia.
- Cut-off limit:
- WHO & RCOG: 11 g/dL.
- CDC Trimester-wise & Postnatal Values:
- 1st & 3rd Trimester: 11 g/dL
- 2nd Trimester: 10.5 g/dL
- Postnatal Period: 10 g/dL
- WHO Classification of Anaemia Severity:
- Mild: 10-10.9 g/dL
- Moderate: 7-9.9 g/dL
- Severe: < 7 g/dL
- 🔹 Haemoglobin (Hb) Screening Test: 🩸
a) Macrocytic anemia
-
🔹 Full Blood Count (FBC), Red Cell Indices & RBC Morphology: 🧬
- 1st line investigation advised at booking and 28 weeks.
- Red Cell Indices help in iron deficiency anaemia detection (if no chronic disease/haemoglobinopathy).
- Blood count abnormalities:
- ↓ RBC, WBC, Platelets → Aplastic anaemia (confirm with bone marrow study).
- RBC INDICES (MCV, MCH, MCHC) Differentiation:
- Microcytic, hypochromic (↓ MCV, MCH, MCHC) → Iron deficiency anaemia
- ↓ MCV, ↓ MCH, normal MCHC → Haemoglobinopathies
-
🔹 Serum Ferritin: 🧪
- Most specific test for total body iron stores (in absence of inflammation).
- Not affected by recent iron ingestion.
- Ferritin Levels Interpretation:
- < 30 µg/L → Needs treatment.
- < 15 µg/L → Diagnostic of iron deficiency.
Options:
a) 1350 mg
b) 1000 mg
c) 90 mg
d) 60 mg
✅ Correct Answer: c) 1350 mg
Simplified Explanation:
- The total iron requirement during pregnancy is approximately 1250 mg to support fetal growth, maternal blood expansion, and iron losses.
- near to that is 1350
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😊SOGP
- First screening test for iron deficiency anaemia.
- Cut-off limit:
- WHO & RCOG: 11 g/dL.
- CDC Trimester-wise & Postnatal Values:
- 1st & 3rd Trimester: 11 g/dL
- 2nd Trimester: 10.5 g/dL
- Postnatal Period: 10 g/dL
- WHO Classification of Anaemia Severity:
- Mild: 10-10.9 g/dL
- Moderate: 7-9.9 g/dL
- Severe: < 7 g/dL
- 🔹 Haemoglobin (Hb) Screening Test: 🩸
a) Macrocytic anemia
🔹 Full Blood Count (FBC), Red Cell Indices & RBC Morphology: 🧬
- 1st line investigation advised at booking and 28 weeks.
- Red Cell Indices help in iron deficiency anaemia detection (if no chronic disease/haemoglobinopathy).
- Blood count abnormalities:
- ↓ RBC, WBC, Platelets → Aplastic anaemia (confirm with bone marrow study).
- RBC INDICES (MCV, MCH, MCHC) Differentiation:
- Microcytic, hypochromic (↓ MCV, MCH, MCHC) → Iron deficiency anaemia
- ↓ MCV, ↓ MCH, normal MCHC → Haemoglobinopathies
🔹 Serum Ferritin: 🧪
- Most specific test for total body iron stores (in absence of inflammation).
- Not affected by recent iron ingestion.
- Ferritin Levels Interpretation:
- < 30 µg/L → Needs treatment.
- < 15 µg/L → Diagnostic of iron deficiency.
Second-Line Investigations
-
🔹 Other Indicators of Iron Deficiency Anaemia: 🔬
- Low transferrin saturation
- Low serum iron levels
- Raised total iron-binding capacity (TIBC)
- Raised red cell zinc protoporphyrin
- Increased serum transferrin receptors (sTfR)
- Transferrin saturation (TSAT) – Alternative to serum ferritin.
- Serum transferrin receptor – Not widely used in clinical practice.
🩸 Recommendations for Iron Deficiency Anaemia
🔹 Other Indicators of Iron Deficiency Anaemia: 🔬
- Low transferrin saturation
- Low serum iron levels
- Raised total iron-binding capacity (TIBC)
- Raised red cell zinc protoporphyrin
- Increased serum transferrin receptors (sTfR)
- Transferrin saturation (TSAT) – Alternative to serum ferritin.
- Serum transferrin receptor – Not widely used in clinical practice.
-
🔹 Cut-off value for Hb:
- < 11 g/dl in 1st and 3rd trimester
- < 10.5 g/dl in 2nd trimester
-
🔹 Prophylactic daily dose: 💊
- 60 mg of elemental iron recommended for non-anaemic pregnant mothers.
-
🔹 High-dose IV iron therapy: 💉
- Iron sucrose or Ferric Carboxymaltose (FCM) should be given to pregnant mothers with:
- Hb < 10.5 g/dL in the 2nd trimester
- Hb < 11 g/dL in the 3rd trimester
-
🔹 Alternative treatment where IV iron is unavailable:
- Anaemic pregnant women should be treated with daily iron (120 mg elemental iron) + folic acid (400 µg or 0.4 mg) until Hb normalizes.
- Once Hb levels are normal, they can switch to the standard antenatal dose to prevent recurrence.
-
🔹 Blood transfusion recommendation: 🩸
- If Hb < 7 g/dL in the 2nd and 3rd trimester, blood transfusion should be considered after evaluating risks & benefits.
-
🔹 Folic acid supplementation: 🌿
- Should be commenced as early as possible (ideally before conception) to prevent neural tube defects.
-
🔹 Higher doses in severe public health settings:
- In regions where anaemia in pregnancy is ≥ 40% (e.g., Pakistan), a daily dose of 60 mg of elemental iron is preferred over a lower dose.
🔹 Cut-off value for Hb:
- < 11 g/dl in 1st and 3rd trimester
- < 10.5 g/dl in 2nd trimester
🔹 Prophylactic daily dose: 💊
- 60 mg of elemental iron recommended for non-anaemic pregnant mothers.
🔹 High-dose IV iron therapy: 💉
- Iron sucrose or Ferric Carboxymaltose (FCM) should be given to pregnant mothers with:
- Hb < 10.5 g/dL in the 2nd trimester
- Hb < 11 g/dL in the 3rd trimester
🔹 Alternative treatment where IV iron is unavailable:
- Anaemic pregnant women should be treated with daily iron (120 mg elemental iron) + folic acid (400 µg or 0.4 mg) until Hb normalizes.
- Once Hb levels are normal, they can switch to the standard antenatal dose to prevent recurrence.
🔹 Blood transfusion recommendation: 🩸
- If Hb < 7 g/dL in the 2nd and 3rd trimester, blood transfusion should be considered after evaluating risks & benefits.
🔹 Folic acid supplementation: 🌿
- Should be commenced as early as possible (ideally before conception) to prevent neural tube defects.
🔹 Higher doses in severe public health settings:
- In regions where anaemia in pregnancy is ≥ 40% (e.g., Pakistan), a daily dose of 60 mg of elemental iron is preferred over a lower dose.
Recommendations for Immediate & Late Postpartum Care
-
🔹 Immediate postpartum care (within 24 hours): ⏳
- If Hb < 10 g/dL, the patient should not be discharged from the hospital.
- Such patients should receive a single shot of high-dose IV iron (e.g., FCM/Iron Sucrose).
- If Hb > 10 g/dL, ferritin is normal, and the patient is haemodynamically stable, she may be discharged with oral iron therapy (as per the discretion of the health professional).
-
🔹 Late postpartum care (after 24 hours):
- Patients returning with Hb < 10 g/dL should also be given IV iron (e.g., FCM and/or Iron Sucrose).
-
🔹 Oral iron supplementation: 💊
- 120 mg elemental iron + 400 µg folic acid (alone or in combination) should be provided for 6–12 weeks postpartum to reduce anaemia risk in regions with high gestational anaemia rates.
-
🔹 Blood transfusion for severe anaemia: 🩸
- All women with Hb < 7 g/dL should be considered for transfusion to achieve Hb > 7 g/dL.
-
🔹 Contraceptive advice: 🔄
- Mandatory for all patients to prevent complications related to iron-deficiency anaemia.
🔹 Immediate postpartum care (within 24 hours): ⏳
- If Hb < 10 g/dL, the patient should not be discharged from the hospital.
- Such patients should receive a single shot of high-dose IV iron (e.g., FCM/Iron Sucrose).
- If Hb > 10 g/dL, ferritin is normal, and the patient is haemodynamically stable, she may be discharged with oral iron therapy (as per the discretion of the health professional).
🔹 Late postpartum care (after 24 hours):
- Patients returning with Hb < 10 g/dL should also be given IV iron (e.g., FCM and/or Iron Sucrose).
🔹 Oral iron supplementation: 💊
- 120 mg elemental iron + 400 µg folic acid (alone or in combination) should be provided for 6–12 weeks postpartum to reduce anaemia risk in regions with high gestational anaemia rates.
🔹 Blood transfusion for severe anaemia: 🩸
- All women with Hb < 7 g/dL should be considered for transfusion to achieve Hb > 7 g/dL.
🔹 Contraceptive advice: 🔄
- Mandatory for all patients to prevent complications related to iron-deficiency anaemia.
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