IT Quiz Answer – August 15, 2024
Answers from our weekly Intelligent Thursday quizzes!
Pop Quiz: August 15, 2024
A 73-year-old patient with CKD G4/A3 due to hypertension is being treated for anemia with erythropoiesis-stimulating agents (ESAs). The ESA dosing has been increased every two weeks for the last three months, but the patient’s hemoglobin has not reached the treatment goal. The patient’s hemoglobin has consistently remained < 10 g / dL.
Answer: Order iron studies
Explanation:
In this case you want to check for ESA resistance by performing iron studies. This includes the serum ferritin (measuring the protein that stores iron in the cells), the transferrin saturation (or TSAT which measures the amount of bound iron in the blood), and reticulocyte hemoglobin content (the amount of iron associated with new red blood cells). Iron deficiency, inflammation and infection are all reasons for ESA resistance. There are no indications that this patient requires a blood transfusion. This would only be done if the hemoglobin is less than 7 g/dL. And because the patient is not responding to ESA therapy, changing ESA brands or switching to a hypoxia-inducible factor prolyl hydroxylase inhibitor (or HIF-PH) would not improve hemoglobin.
Lastly, you should not stop ESA therapy. This would not address the problem and would likely lead to a further decrease in hemoglobin.
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