A 50-year-old woman presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. The woman has a history of congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease. The CBC results indicate hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patient’s vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. The practitioner suspects the low hemoglobin level is related to the decline in kidney function and begins to address treatment related to the condition. Discuss the following:
- Which test(s) should be performed to determine whether the anemia is related to chronic disease or iron deficiency, and what would those results show?
- Should the practitioner consider a blood transfusion for this patient? Explain your answer.
- Which medication(s) should be considered for this patient?
- What considerations should the practitioner include in the care of the patient if erythropoietic agents are used for treatment?
- What follow-up should the practitioner recommend for the patient?
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!
Step 1: Understand the Case
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Patient: 50-year-old woman with fatigue, SOB, anemia (Hgb 9.5 g/dL, Hct 29%), history of CHF and chronic kidney disease (CKD).
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Rule-outs: no acute illness, no worsening CHF, no worsening kidney disease.
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Key focus: Is this anemia due to iron deficiency or CKD-related anemia?
Step 2: Identify the Required Tests
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Order labs to distinguish between anemia of chronic disease vs. iron deficiency:
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Ferritin: low in iron deficiency, normal/high in chronic disease.
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Serum iron and Total Iron Binding Capacity (TIBC):
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Iron deficiency = low serum iron, high TIBC.
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Anemia of chronic disease = low serum iron, low/normal TIBC.
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Transferrin saturation (TSAT): <20% suggests iron deficiency.
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Be ready to explain expected results for both conditions.
Step 3: Discuss Blood Transfusion
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Consider transfusion if:
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Hemoglobin <7–8 g/dL or patient has severe symptoms (dyspnea, chest pain, tachycardia).
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In this case: Hgb 9.5 g/dL, stable vitals → not an immediate candidate for transfusion.
Step 4: Consider Medications
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If anemia is due to CKD:
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Erythropoiesis-stimulating agents (ESAs) such as epoetin alfa or darbepoetin alfa.
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Iron supplementation (oral or IV depending on iron studies).
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Cite guidelines such as KDIGO (Kidney Disease: Improving Global Outcomes) for thresholds.
Step 5: Safety Considerations with ESAs
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Risks: hypertension, thromboembolic events, stroke, and rapid rise in Hgb.
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Target Hgb: usually 10–11.5 g/dL (avoid >13 g/dL).
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Monitor blood pressure and iron levels during therapy.
Step 6: Outline Follow-Up
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Recheck CBC and iron studies every 4–6 weeks after starting therapy.
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Monitor kidney function, blood pressure, and symptoms.
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Adjust ESA dose as needed to maintain safe Hgb levels.
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Long-term: coordinate care with nephrology and cardiology.
Step 7: Write Your Paper (500+ words, APA format)
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Introduction: Present patient’s case and importance of evaluating anemia in CKD.
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Body Paragraph 1: Discuss appropriate labs to differentiate anemia types and expected results.
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Body Paragraph 2: Address transfusion decision and rationale.
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Body Paragraph 3: Review medication options (iron, ESA).
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Body Paragraph 4: Explain considerations and risks of ESAs.
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Body Paragraph 5: Provide recommendations for follow-up care.
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Conclusion: Summarize best practices for managing anemia in CKD.
Resources to Use in Your Paper:
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KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease: Anemia in Chronic Kidney Disease: Diagnosis and Management appeared first on Skilled Papers.
