A 69-year-old woman with CKD G4 has fatigue. Hemoglobin is 92 g/L, MCV is 88 fL, ferritin is 38 microgram/L and transferrin saturation is 13%. B12

Question

A 69-year-old woman with CKD G4 has fatigue. Hemoglobin is 92 g/L, MCV is 88 fL, ferritin is 38 microgram/L and transferrin saturation is 13%. B12 and folate are normal. There is no overt bleeding. What is the most appropriate next step?

Accepted Answer

Replete iron stores before considering erythropoiesis-stimulating therapy

Answer

Start erythropoietin without checking iron status

Answer

Treat with phlebotomy

Answer

Begin high-dose prednisone

Answer

Transfuse red cells as chronic first-line therapy

Anemia of chronic kidney disease — RCPSC IM MCQ

A 69-year-old woman with CKD G4 has fatigue. Hemoglobin is 92 g/L, MCV is 88 fL, ferritin is 38 microgram/L and transferrin saturation is 13%. B12 and folate are normal. There is no overt bleeding. What is the most appropriate next step?