Question

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. Lead poisoning
• B. Iron deficiency anemia
• C. Chronic alcoholism
• D. Hemolytic anemia

Hint:

The smear is intentionally mixed; the key leans on the toxic cause that disturbs haem synthesis in a young man without alcohol history.

Answer 1

The Correct Option is A

Correct answer (as per the recall key): Lead poisoning.
Step 1: This is a deliberately mixed picture. Microcytic RBCs point toward an iron or sideroblastic process, while hypersegmented neutrophils point toward a megaloblastic (B12 or folate) process. The MCV of 101 fL is at the upper-normal to mildly raised range, so the smear, not the index, must guide the answer.
Step 2: Lead poisoning can produce a microcytic anemia with basophilic stippling and interferes with haem synthesis; the key takes the combination of fatigue with these mixed findings as pointing to lead. Iron deficiency alone would not give hypersegmented neutrophils. Hemolytic anemia would show reticulocytosis and schistocytes or spherocytes, not described here. Chronic alcoholism is less likely in a young patient with no drinking history.
Step 3: The findings are intentionally contradictory in this memory-based item. Following the marked key, lead poisoning is selected. In real practice, hypersegmented neutrophils with a raised MCV would prompt a B12 or folate workup.
Ref: recall key, NEET PG 2020.