Anemia in Chronic Kidney Disease Quiz

A 62-year-old man with CKD stage 4 presents with progressive fatigue and dyspnea on exertion. His hemoglobin is 9.2 g/dL, MCV 90 fL, ferritin 450 ng/mL, TSAT 30%, and reticulocyte count low. What is the most likely cause of his anemia?

• Iron deficiency anemia

• Erythropoietin deficiency

• Hemolysis due to uremia

• Anemia of chronic inflammation

A 65-year-old CKD stage 5 patient has a hemoglobin of 8.5 g/dL. His reticulocyte count is low, ferritin is 400 ng/mL, and TSAT is 30%. What does the low reticulocyte count indicate?

• Ongoing hemolysis

• Bone marrow suppression

• Iron-restricted erythropoiesis

• Vitamin B12 deficiency

A 70-year-old CKD stage 5 patient has a hemoglobin of 9.0 g/dL, ferritin 800 ng/mL, and TSAT 18%. What is the most likely cause of his anemia?

• Absolute iron deficiency

• Functional iron deficiency

• Hemoglobinopathy

• ESA resistance

A 55-year-old CKD stage 4 patient has hemoglobin 9.5 g/dL, MCV 105 fL, and B12 levels normal. What is the most likely cause of macrocytosis?

• CKD-related anemia

• Folate deficiency

• Uremic toxicity

• Hemolysis

A 65-year-old woman with CKD stage 4 has hemoglobin 8.8 g/dL and high RDW. What does an elevated RDW suggest?

• Early iron deficiency

• Pure Red Cell Aplasia

• Myelodysplastic syndrome

• Beta-thalassemia minor

A dialysis patient has persistent anemia despite adequate iron and ESA therapy. Which uremic toxin most contributes to erythropoietin resistance?

• Indoxyl sulfate

• Urea

• Creatinine

• Homocysteine

A CKD stage 5 patient on ESA therapy has persistent anemia and elevated CRP. What is the most likely cause of ESA resistance?

• Functional iron deficiency

• Hypothyroidism

• Bone marrow failure

• Hyperparathyroidism

A dialysis patient has worsening anemia despite adequate ESA therapy. His labs show MCV of 97, Ferritin of 450 ng/ml, Tsats of 35%, Normal Vitamin B12 and RBC Folate levels, and Intact PTH of 1100 IU/L. What is the best next step?

• Increase ESA dose

• Check bone marrow biopsy

• Treat secondary hyperparathyroidism

• Start blood transfusions

A CKD stage 4 patient on ESA therapy has hemoglobin 13.5 g/dL. What should be done next?

• Continue current ESA dose

• Reduce ESA dose

• Increase ESA dose

• Check ferritin and TSAT

A dialysis patient on ESA therapy for 6 months develops sudden worsening anemia (Hb 6.5 g/dL) with very low reticulocyte count. What is the most likely diagnosis?

• Functional iron deficiency

• ESA-induced pure red cell aplasia

• Myelofibrosis

• Hemolysis