Question:hard
A 23-year-old male presents with fatigue and tiredness. Investigations show Hb 9 g%, MCV 101 fL. The peripheral smear shows microcytic RBCs and hypersegmented neutrophils. Which is the most probable etiology?
A 23-year-old male presents with fatigue and tiredness. Investigations show Hb 9 g%, MCV 101 fL. The peripheral smear shows microcytic RBCs and hypersegmented neutrophils. Which is the most probable etiology?
Show Hint
The smear is intentionally mixed; the key leans on the toxic cause that disturbs haem synthesis in a young man without alcohol history.
Updated On: Jun 23, 2026
- Lead poisoning
- Iron deficiency anemia
- Chronic alcoholism
- Hemolytic anemia
Show Solution
The Correct Option is A
Solution and Explanation
Treat this as a clue-sorting puzzle: the question mixes a microcytic smear with hypersegmented neutrophils, two features that usually point in opposite directions.
Walk the options: iron deficiency anemia gives microcytosis but never hypersegmented neutrophils, so it cannot explain the full picture. Hemolytic anemia shows reticulocytosis with schistocytes, spherocytes, or bite cells, none mentioned here, so it is unlikely. Chronic alcoholism is a reasonable cause of macrocytosis, but the patient is young with no drinking history given, which the key uses to exclude it.
What the key chooses: lead poisoning, a toxin that disrupts haem synthesis and can give a microcytic anemia with basophilic stippling, fitting the fatigue and mixed findings.
Caveat: the labs are internally contradictory in this recalled item; clinically, hypersegmented neutrophils with a high MCV would push you to check B12 and folate first.
Reference: anemia approach, NEET PG recall.
Walk the options: iron deficiency anemia gives microcytosis but never hypersegmented neutrophils, so it cannot explain the full picture. Hemolytic anemia shows reticulocytosis with schistocytes, spherocytes, or bite cells, none mentioned here, so it is unlikely. Chronic alcoholism is a reasonable cause of macrocytosis, but the patient is young with no drinking history given, which the key uses to exclude it.
What the key chooses: lead poisoning, a toxin that disrupts haem synthesis and can give a microcytic anemia with basophilic stippling, fitting the fatigue and mixed findings.
Caveat: the labs are internally contradictory in this recalled item; clinically, hypersegmented neutrophils with a high MCV would push you to check B12 and folate first.
Reference: anemia approach, NEET PG recall.
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