A 70-year-old woman with stage 4 chronic kidney disease has fatigue. Hemoglobin is 9.4 g/dL, ferritin is 45 ng/mL, transferrin saturation is 14%, B12

Question

A 70-year-old woman with stage 4 chronic kidney disease has fatigue. Hemoglobin is 9.4 g/dL, ferritin is 45 ng/mL, transferrin saturation is 14%, B12 is normal, and stool testing is negative. She has no chest pain or active bleeding. Which of the following is the most appropriate next step in management?

Accepted Answer

Replete iron before considering erythropoiesis-stimulating therapy

Answer

Begin empiric chemotherapy

Answer

Transfuse packed cells routinely at this level

Answer

Start erythropoietin without iron assessment

Answer

Prescribe oral prednisone

Chronic kidney disease anemia — USMLE Step 3 MCQ