This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Hemolytic anemia, Subject name: Pathology
All are seen in Thalassemia major EXCEPT: 
Select and explain. 
A. Transfusion dependency, B. Splenoheptatomegaly, C. Ineffective erythropoiesis, D. Macrocytic anemia
D: Macrocytic anemia
Answer: D: Macrocytic anemia 
Explanation: Ans. (d) Macrocytic anaemiaRef. Robbins pathology 9th ed. /638* Thalassemia major presents before 1 yr of age with severe anemia which necessitates packed RBC transfusions every 2-3 months. The child is said to be transfusion dependent as survival is decided by RBC being transfused.* The ineffective erythropoiesis in bone marrow results in shift of hematopoiesis to liver and the bone marrow. Hence the liver and spleen enlarge in size. But the net result is defective microcytes being produced. The type of anaemia is microcytic hypochromic anaemia.* Remember: causes of MACROCYTIC ANAEMIA: "ABCDEF":# Alcohol + liver disease# B12 deficiency# Compensatory reticulocytosis (blood loss and hemolysis)# Drug (cytotoxic and AZT)/ Dysplasia (marrow problems)# Endocrine (hypothyroidism)# Folate deficieny/Fetus (pregnancy)