NUR 6121 Quiz 1: Lab Tests and Anemia Insights | Questions
and Answers | 2026 Update | Graded A+ William Paterson
University. - 150 Questions
Section 1: Complete Blood Count (CBC) Interpretation (Questions 1-15)
1 A patient's CBC reveals: Hb 9.2 g/dL, MCV 72 fL, MCH 24 pg, RDW 18.5%. Ferritin is low, serum iron low,
TIBC elevated. Which additional finding is most likely to be present on peripheral smear?
A) Target cells and basophilic stippling
B) Microcytic hypochromic cells with pencil cells
C) Schistocytes and helmet cells
D) Spherocytes and polychromasia
Answer: B
Rationale: The profile is classic iron deficiency anemia: microcytic (low MCV), hypochromic (low MCH), elevated
RDW indicates anisocytosis. Pencil cells (elliptocytes) are characteristic of iron deficiency. Target cells are seen in
thalassemia or liver disease; basophilic stippling suggests lead poisoning or thalassemia. Schistocytes indicate
microangiopathic hemolytic anemia. Spherocytes suggest hereditary spherocytosis or autoimmune hemolysis.
2 A CBC shows: WBC 12.5 × 10^9/L, Hb 10.8 g/dL, MCV 110 fL, platelet count 450 × 10^9/L. Differential:
neutrophils 45%, lymphocytes 40%, monocytes 10%, eosinophils 3%, basophils 2%. Which condition is most
consistent with these findings?
A) Chronic myeloid leukemia with left shift
B) Autoimmune hemolytic anemia with reticulocytosis
C) Megaloblastic anemia due to vitamin B12 deficiency
D) Acute lymphoblastic leukemia
Answer: C
Rationale: Macrocytic anemia (high MCV) with pancytopenia (anemia, relative lymphocytosis, thrombocytosis may
be reactive) is typical of megaloblastic anemia. The differential shows no left shift or blasts, ruling out leukemia.
Autoimmune hemolytic anemia usually has reticulocytosis (high MCV but also high RDW, spherocytes). CML
would show marked neutrophilia with left shift. ALL would have blasts.
3 A patient's CBC: Hb 7.0 g/dL, MCV 65 fL, MCH 20 pg, RBC count 5.8 × 10^12/L, RDW 14%. Ferritin normal,
serum iron normal, TIBC normal. Hemoglobin electrophoresis shows elevated HbA2 (5.5%). Which additional
finding is expected?
A) Increased reticulocyte count
B) Basophilic stippling on smear
C) Positive direct Coombs test
D) Low haptoglobin
Answer: B
Rationale: This is beta-thalassemia trait: microcytosis out of proportion to anemia, elevated RBC count, normal
RDW, elevated HbA2. Basophilic stippling is common in thalassemias due to impaired hemoglobin synthesis.
Reticulocytosis suggests hemolysis or blood loss, not typical for thalassemia trait. Direct Coombs positive indicates
autoimmune hemolysis. Low haptoglobin occurs in hemolytic anemias.
,4 A CBC report: WBC 3.2 × 10^9/L, Hb 8.5 g/dL, MCV 98 fL, platelet count 50 × 10^9/L. Differential:
neutrophils 20%, lymphocytes 70%, monocytes 8%, eosinophils 1%, basophils 1%. A bone marrow biopsy
shows hypocellularity with 30% cellularity and no fibrosis. Which of the following is the most likely diagnosis?
A) Aplastic anemia
B) Myelodysplastic syndrome
C) Acute myeloid leukemia
D) Chronic lymphocytic leukemia
Answer: A
Rationale: Pancytopenia (low WBC, Hb, platelets) with a hypocellular marrow (30%) and no fibrosis is classic for
aplastic anemia. MDS typically shows hypercellular or normocellular marrow with dysplasia. AML has >20%
blasts. CLL would show lymphocytosis and marrow infiltration with lymphocytes, not hypocellularity.
5 A patient with known chronic kidney disease (CKD) stage 4 has Hb 8.2 g/dL, MCV 82 fL, reticulocyte count
1.2%, ferritin 200 ng/mL, transferrin saturation 25%, erythropoietin level 12 mIU/mL (normal 4-26). Which
intervention is most appropriate?
A) Iron supplementation alone
B) Erythropoiesis-stimulating agent (ESA) alone
C) Both iron and ESA
D) Transfusion of packed red blood cells
Answer: B
Rationale: In CKD anemia, ESA is indicated when Hb <10 g/dL and iron stores are adequate (ferritin >100, TSAT
>20%). Here iron indices are sufficient, so iron is not needed. ESA alone is appropriate. Transfusion is reserved for
severe symptomatic anemia or ESA failure. Low reticulocyte count suggests inadequate erythropoietin response
despite normal endogenous EPO level (relative deficiency).
6 A CBC reveals: Hb 11.5 g/dL, MCV 85 fL, RDW 12.5%, WBC and platelets normal. Reticulocyte count 0.5%.
Serum creatinine 3.0 mg/dL, BUN 40 mg/dL. Which of the following best explains the anemia?
A) Decreased erythropoietin production
B) Iron deficiency
C) Folate deficiency
D) Acute blood loss
Answer: A
Rationale: Normocytic anemia with low reticulocyte count in the setting of renal impairment indicates anemia of
chronic kidney disease due to insufficient erythropoietin. Iron deficiency would show low ferritin, low TSAT, and
possibly microcytosis. Folate deficiency would cause macrocytosis. Acute blood loss would trigger reticulocytosis.
7 A patient's CBC: Hb 9.8 g/dL, MCV 78 fL, MCH 25 pg, RDW 16%. Ferritin 12 ng/mL, serum iron 30 mcg/dL,
TIBC 480 mcg/dL. Which of the following is most likely to be decreased?
A) Haptoglobin
B) Reticulocyte count
C) Total iron-binding capacity
D) Hemoglobin A2
Answer: B
Rationale: Iron deficiency anemia leads to decreased reticulocyte count due to insufficient iron for erythropoiesis.
Haptoglobin is decreased in hemolysis, not iron deficiency. TIBC is elevated (480 is high). Hemoglobin A2 is
elevated in beta-thalassemia trait, not iron deficiency; in iron deficiency, HbA2 may be decreased.
, 8 A CBC: WBC 15.0 × 10^9/L, Hb 11.2 g/dL, MCV 90 fL, platelet count 600 × 10^9/L. Differential: neutrophils
80%, bands 10%, lymphocytes 8%, monocytes 2%. Which of the following is most consistent with this pattern?
A) Chronic myeloid leukemia
B) Acute infection
C) Polycythemia vera
D) Essential thrombocythemia
Answer: B
Rationale: Neutrophilia with left shift (bands) and reactive thrombocytosis is typical of acute infection or
inflammation. CML would show more marked leukocytosis (often >100,000) with basophilia and no left shift.
Polycythemia vera would have elevated Hb and hematocrit. Essential thrombocythemia would have isolated
thrombocytosis without leukocytosis or left shift.
9 A patient has Hb 6.5 g/dL, MCV 115 fL, RDW 22%, reticulocyte count 8%. Peripheral smear shows
macrocytes, hypersegmented neutrophils, and occasional megaloblasts. Which laboratory finding is most likely
to confirm the diagnosis?
A) Elevated serum ferritin
B) Low serum vitamin B12 level
C) Elevated lactate dehydrogenase
D) Positive direct antiglobulin test
Answer: B
Rationale: Macrocytic anemia with elevated RDW and reticulocytosis (inappropriate for the degree of anemia)
suggests megaloblastic anemia. Hypersegmented neutrophils and megaloblasts are pathognomonic. Low B12 or
folate is the cause. LDH is often elevated but nonspecific. Ferritin is normal or high. Direct antiglobulin test
positive would indicate autoimmune hemolysis, which typically shows spherocytes, not hypersegmented
neutrophils.
10 A CBC: Hb 10.0 g/dL, MCV 80 fL, MCHC 33 g/dL, RDW 13%. Reticulocyte count 3.5%. Which of the
following is the most likely explanation?
A) Chronic disease with mild anemia
B) Early iron deficiency
C) Hemoglobinopathy with normal indices
D) Acute blood loss with compensatory reticulocytosis
Answer: A
Rationale: Normocytic, normochromic anemia with low reticulocyte count (3.5% is not elevated given Hb 10;
absolute reticulocyte count would be low) is typical of anemia of chronic disease. Early iron deficiency would
show low ferritin and possibly elevated RDW before microcytosis develops. Hemoglobinopathies often have
abnormal indices. Acute blood loss would show higher reticulocyte count (e.g., >5%).
11 A patient's CBC reveals hemoglobin 9.2 g/dL, MCV 72 fL, MCH 24 pg, and RDW 16.5%. Which of the
following is the most likely differential diagnosis based on these indices?
A) Iron deficiency anemia with early iron depletion
B) Thalassemia trait with normal RDW
C) Anemia of chronic disease with microcytosis
D) Sideroblastic anemia with dimorphic population
Answer: A
Rationale: The low MCV and MCH with elevated RDW indicate microcytic hypochromic anemia with anisocytosis,
classic for iron deficiency anemia. Thalassemia trait typically has normal or minimally elevated RDW. Anemia of
, chronic disease is usually normocytic. Sideroblastic anemia often shows a dimorphic population but not
consistently elevated RDW.
12 A CBC report shows hemoglobin 7.8 g/dL, reticulocyte count 0.5%, and absolute reticulocyte count 15,000/L.
The corrected reticulocyte count (CRC) is 0.3%. Which of the following best explains these findings?
A) Acute blood loss with appropriate bone marrow response
B) Hypoproliferative anemia due to bone marrow failure
C) Hemolytic anemia with adequate marrow compensation
D) Ineffective erythropoiesis due to vitamin B12 deficiency
Answer: B
Rationale: The low reticulocyte count and CRC indicate inadequate bone marrow production, consistent with
hypoproliferative anemia such as aplastic anemia or pure red cell aplasia. Acute blood loss would show high
reticulocytes. Hemolytic anemia has elevated reticulocytes. Ineffective erythropoiesis in B12 deficiency typically
has a high reticulocyte production index but low absolute count due to intramedullary destruction.
13 A patient has WBC 12,000/L, hemoglobin 10.5 g/dL, platelet count 450,000/L, and MCV 84 fL. The
differential shows 60% neutrophils, 25% lymphocytes, 10% monocytes, 3% eosinophils, 2% basophils. Which
of the following is the most appropriate next step in interpretation?
A) Evaluate for infection or inflammation due to leukocytosis and thrombocytosis
B) Assess iron stores because of normocytic anemia with reactive thrombocytosis
C) Repeat CBC in 1 month; findings are likely transient and benign
D) Perform peripheral smear to rule out myeloproliferative neoplasm
Answer: D
Rationale: The combination of normocytic anemia, leukocytosis, and thrombocytosis raises concern for a
myeloproliferative neoplasm (e.g., polycythemia vera with relative anemia, essential thrombocythemia, or chronic
myeloid leukemia). Peripheral smear is essential to evaluate for blasts, left shift, or abnormal platelets. While
infection can cause reactive changes, the triad of abnormalities warrants further investigation. Iron deficiency
anemia typically causes microcytosis and thrombocytosis but not leukocytosis.
14 Which of the following CBC parameters is most useful in distinguishing iron deficiency anemia from anemia
of chronic disease when ferritin levels are equivocal (e.g., 30-100 ng/mL)?
A) Mean corpuscular volume (MCV)
B) Red cell distribution width (RDW)
C) Absolute reticulocyte count
D) Hemoglobin concentration
Answer: B
Rationale: RDW is typically elevated in iron deficiency anemia due to heterogeneous cell sizes, whereas anemia of
chronic disease usually has a normal RDW. MCV can be low in both but is more consistently low in iron
deficiency. Reticulocyte count is not specific. Hemoglobin concentration alone cannot differentiate the two.
15 A CBC shows hemoglobin 11.2 g/dL, MCV 100 fL, MCH 34 pg, and RDW 12.5%. The reticulocyte count is
2.5% with an absolute count of 80,000/L. Which of the following is the most likely cause of this macrocytic
anemia?
A) Folate deficiency with early megaloblastic changes
B) Chronic liver disease with target cells
C) Vitamin B12 deficiency with neurologic symptoms
D) Myelodysplastic syndrome with ring sideroblasts
and Answers | 2026 Update | Graded A+ William Paterson
University. - 150 Questions
Section 1: Complete Blood Count (CBC) Interpretation (Questions 1-15)
1 A patient's CBC reveals: Hb 9.2 g/dL, MCV 72 fL, MCH 24 pg, RDW 18.5%. Ferritin is low, serum iron low,
TIBC elevated. Which additional finding is most likely to be present on peripheral smear?
A) Target cells and basophilic stippling
B) Microcytic hypochromic cells with pencil cells
C) Schistocytes and helmet cells
D) Spherocytes and polychromasia
Answer: B
Rationale: The profile is classic iron deficiency anemia: microcytic (low MCV), hypochromic (low MCH), elevated
RDW indicates anisocytosis. Pencil cells (elliptocytes) are characteristic of iron deficiency. Target cells are seen in
thalassemia or liver disease; basophilic stippling suggests lead poisoning or thalassemia. Schistocytes indicate
microangiopathic hemolytic anemia. Spherocytes suggest hereditary spherocytosis or autoimmune hemolysis.
2 A CBC shows: WBC 12.5 × 10^9/L, Hb 10.8 g/dL, MCV 110 fL, platelet count 450 × 10^9/L. Differential:
neutrophils 45%, lymphocytes 40%, monocytes 10%, eosinophils 3%, basophils 2%. Which condition is most
consistent with these findings?
A) Chronic myeloid leukemia with left shift
B) Autoimmune hemolytic anemia with reticulocytosis
C) Megaloblastic anemia due to vitamin B12 deficiency
D) Acute lymphoblastic leukemia
Answer: C
Rationale: Macrocytic anemia (high MCV) with pancytopenia (anemia, relative lymphocytosis, thrombocytosis may
be reactive) is typical of megaloblastic anemia. The differential shows no left shift or blasts, ruling out leukemia.
Autoimmune hemolytic anemia usually has reticulocytosis (high MCV but also high RDW, spherocytes). CML
would show marked neutrophilia with left shift. ALL would have blasts.
3 A patient's CBC: Hb 7.0 g/dL, MCV 65 fL, MCH 20 pg, RBC count 5.8 × 10^12/L, RDW 14%. Ferritin normal,
serum iron normal, TIBC normal. Hemoglobin electrophoresis shows elevated HbA2 (5.5%). Which additional
finding is expected?
A) Increased reticulocyte count
B) Basophilic stippling on smear
C) Positive direct Coombs test
D) Low haptoglobin
Answer: B
Rationale: This is beta-thalassemia trait: microcytosis out of proportion to anemia, elevated RBC count, normal
RDW, elevated HbA2. Basophilic stippling is common in thalassemias due to impaired hemoglobin synthesis.
Reticulocytosis suggests hemolysis or blood loss, not typical for thalassemia trait. Direct Coombs positive indicates
autoimmune hemolysis. Low haptoglobin occurs in hemolytic anemias.
,4 A CBC report: WBC 3.2 × 10^9/L, Hb 8.5 g/dL, MCV 98 fL, platelet count 50 × 10^9/L. Differential:
neutrophils 20%, lymphocytes 70%, monocytes 8%, eosinophils 1%, basophils 1%. A bone marrow biopsy
shows hypocellularity with 30% cellularity and no fibrosis. Which of the following is the most likely diagnosis?
A) Aplastic anemia
B) Myelodysplastic syndrome
C) Acute myeloid leukemia
D) Chronic lymphocytic leukemia
Answer: A
Rationale: Pancytopenia (low WBC, Hb, platelets) with a hypocellular marrow (30%) and no fibrosis is classic for
aplastic anemia. MDS typically shows hypercellular or normocellular marrow with dysplasia. AML has >20%
blasts. CLL would show lymphocytosis and marrow infiltration with lymphocytes, not hypocellularity.
5 A patient with known chronic kidney disease (CKD) stage 4 has Hb 8.2 g/dL, MCV 82 fL, reticulocyte count
1.2%, ferritin 200 ng/mL, transferrin saturation 25%, erythropoietin level 12 mIU/mL (normal 4-26). Which
intervention is most appropriate?
A) Iron supplementation alone
B) Erythropoiesis-stimulating agent (ESA) alone
C) Both iron and ESA
D) Transfusion of packed red blood cells
Answer: B
Rationale: In CKD anemia, ESA is indicated when Hb <10 g/dL and iron stores are adequate (ferritin >100, TSAT
>20%). Here iron indices are sufficient, so iron is not needed. ESA alone is appropriate. Transfusion is reserved for
severe symptomatic anemia or ESA failure. Low reticulocyte count suggests inadequate erythropoietin response
despite normal endogenous EPO level (relative deficiency).
6 A CBC reveals: Hb 11.5 g/dL, MCV 85 fL, RDW 12.5%, WBC and platelets normal. Reticulocyte count 0.5%.
Serum creatinine 3.0 mg/dL, BUN 40 mg/dL. Which of the following best explains the anemia?
A) Decreased erythropoietin production
B) Iron deficiency
C) Folate deficiency
D) Acute blood loss
Answer: A
Rationale: Normocytic anemia with low reticulocyte count in the setting of renal impairment indicates anemia of
chronic kidney disease due to insufficient erythropoietin. Iron deficiency would show low ferritin, low TSAT, and
possibly microcytosis. Folate deficiency would cause macrocytosis. Acute blood loss would trigger reticulocytosis.
7 A patient's CBC: Hb 9.8 g/dL, MCV 78 fL, MCH 25 pg, RDW 16%. Ferritin 12 ng/mL, serum iron 30 mcg/dL,
TIBC 480 mcg/dL. Which of the following is most likely to be decreased?
A) Haptoglobin
B) Reticulocyte count
C) Total iron-binding capacity
D) Hemoglobin A2
Answer: B
Rationale: Iron deficiency anemia leads to decreased reticulocyte count due to insufficient iron for erythropoiesis.
Haptoglobin is decreased in hemolysis, not iron deficiency. TIBC is elevated (480 is high). Hemoglobin A2 is
elevated in beta-thalassemia trait, not iron deficiency; in iron deficiency, HbA2 may be decreased.
, 8 A CBC: WBC 15.0 × 10^9/L, Hb 11.2 g/dL, MCV 90 fL, platelet count 600 × 10^9/L. Differential: neutrophils
80%, bands 10%, lymphocytes 8%, monocytes 2%. Which of the following is most consistent with this pattern?
A) Chronic myeloid leukemia
B) Acute infection
C) Polycythemia vera
D) Essential thrombocythemia
Answer: B
Rationale: Neutrophilia with left shift (bands) and reactive thrombocytosis is typical of acute infection or
inflammation. CML would show more marked leukocytosis (often >100,000) with basophilia and no left shift.
Polycythemia vera would have elevated Hb and hematocrit. Essential thrombocythemia would have isolated
thrombocytosis without leukocytosis or left shift.
9 A patient has Hb 6.5 g/dL, MCV 115 fL, RDW 22%, reticulocyte count 8%. Peripheral smear shows
macrocytes, hypersegmented neutrophils, and occasional megaloblasts. Which laboratory finding is most likely
to confirm the diagnosis?
A) Elevated serum ferritin
B) Low serum vitamin B12 level
C) Elevated lactate dehydrogenase
D) Positive direct antiglobulin test
Answer: B
Rationale: Macrocytic anemia with elevated RDW and reticulocytosis (inappropriate for the degree of anemia)
suggests megaloblastic anemia. Hypersegmented neutrophils and megaloblasts are pathognomonic. Low B12 or
folate is the cause. LDH is often elevated but nonspecific. Ferritin is normal or high. Direct antiglobulin test
positive would indicate autoimmune hemolysis, which typically shows spherocytes, not hypersegmented
neutrophils.
10 A CBC: Hb 10.0 g/dL, MCV 80 fL, MCHC 33 g/dL, RDW 13%. Reticulocyte count 3.5%. Which of the
following is the most likely explanation?
A) Chronic disease with mild anemia
B) Early iron deficiency
C) Hemoglobinopathy with normal indices
D) Acute blood loss with compensatory reticulocytosis
Answer: A
Rationale: Normocytic, normochromic anemia with low reticulocyte count (3.5% is not elevated given Hb 10;
absolute reticulocyte count would be low) is typical of anemia of chronic disease. Early iron deficiency would
show low ferritin and possibly elevated RDW before microcytosis develops. Hemoglobinopathies often have
abnormal indices. Acute blood loss would show higher reticulocyte count (e.g., >5%).
11 A patient's CBC reveals hemoglobin 9.2 g/dL, MCV 72 fL, MCH 24 pg, and RDW 16.5%. Which of the
following is the most likely differential diagnosis based on these indices?
A) Iron deficiency anemia with early iron depletion
B) Thalassemia trait with normal RDW
C) Anemia of chronic disease with microcytosis
D) Sideroblastic anemia with dimorphic population
Answer: A
Rationale: The low MCV and MCH with elevated RDW indicate microcytic hypochromic anemia with anisocytosis,
classic for iron deficiency anemia. Thalassemia trait typically has normal or minimally elevated RDW. Anemia of
, chronic disease is usually normocytic. Sideroblastic anemia often shows a dimorphic population but not
consistently elevated RDW.
12 A CBC report shows hemoglobin 7.8 g/dL, reticulocyte count 0.5%, and absolute reticulocyte count 15,000/L.
The corrected reticulocyte count (CRC) is 0.3%. Which of the following best explains these findings?
A) Acute blood loss with appropriate bone marrow response
B) Hypoproliferative anemia due to bone marrow failure
C) Hemolytic anemia with adequate marrow compensation
D) Ineffective erythropoiesis due to vitamin B12 deficiency
Answer: B
Rationale: The low reticulocyte count and CRC indicate inadequate bone marrow production, consistent with
hypoproliferative anemia such as aplastic anemia or pure red cell aplasia. Acute blood loss would show high
reticulocytes. Hemolytic anemia has elevated reticulocytes. Ineffective erythropoiesis in B12 deficiency typically
has a high reticulocyte production index but low absolute count due to intramedullary destruction.
13 A patient has WBC 12,000/L, hemoglobin 10.5 g/dL, platelet count 450,000/L, and MCV 84 fL. The
differential shows 60% neutrophils, 25% lymphocytes, 10% monocytes, 3% eosinophils, 2% basophils. Which
of the following is the most appropriate next step in interpretation?
A) Evaluate for infection or inflammation due to leukocytosis and thrombocytosis
B) Assess iron stores because of normocytic anemia with reactive thrombocytosis
C) Repeat CBC in 1 month; findings are likely transient and benign
D) Perform peripheral smear to rule out myeloproliferative neoplasm
Answer: D
Rationale: The combination of normocytic anemia, leukocytosis, and thrombocytosis raises concern for a
myeloproliferative neoplasm (e.g., polycythemia vera with relative anemia, essential thrombocythemia, or chronic
myeloid leukemia). Peripheral smear is essential to evaluate for blasts, left shift, or abnormal platelets. While
infection can cause reactive changes, the triad of abnormalities warrants further investigation. Iron deficiency
anemia typically causes microcytosis and thrombocytosis but not leukocytosis.
14 Which of the following CBC parameters is most useful in distinguishing iron deficiency anemia from anemia
of chronic disease when ferritin levels are equivocal (e.g., 30-100 ng/mL)?
A) Mean corpuscular volume (MCV)
B) Red cell distribution width (RDW)
C) Absolute reticulocyte count
D) Hemoglobin concentration
Answer: B
Rationale: RDW is typically elevated in iron deficiency anemia due to heterogeneous cell sizes, whereas anemia of
chronic disease usually has a normal RDW. MCV can be low in both but is more consistently low in iron
deficiency. Reticulocyte count is not specific. Hemoglobin concentration alone cannot differentiate the two.
15 A CBC shows hemoglobin 11.2 g/dL, MCV 100 fL, MCH 34 pg, and RDW 12.5%. The reticulocyte count is
2.5% with an absolute count of 80,000/L. Which of the following is the most likely cause of this macrocytic
anemia?
A) Folate deficiency with early megaloblastic changes
B) Chronic liver disease with target cells
C) Vitamin B12 deficiency with neurologic symptoms
D) Myelodysplastic syndrome with ring sideroblasts
