A 55-year-old man with stage 2 chronic kidney disease is evaluated because of anemia and fatigue. Physical examination reveals pale skin. Which of the following is the most appropr... A 55-year-old man with stage 2 chronic kidney disease is evaluated because of anemia and fatigue. Physical examination reveals pale skin. Which of the following is the most appropriate investigation to be done? A. Serum iron studies B. Reticulocyte count C. Serum erythropoietin level D. Bone marrow aspiration
Understand the Problem
The question describes a patient with chronic kidney disease (CKD) and anemia, presenting with fatigue and pale skin. It asks you to determine the most appropriate initial investigation to identify the cause of the anemia in this patient. We have to decide if iron studies, reticulocyte count, erythropoietin levels, or bone marrow aspiration is the next step.
Answer
C. Serum erythropoietin level
The most appropriate investigation to be done is C. Serum erythropoietin level. Anemia in chronic kidney disease is often due to decreased erythropoietin production by the kidneys.
Answer for screen readers
The most appropriate investigation to be done is C. Serum erythropoietin level. Anemia in chronic kidney disease is often due to decreased erythropoietin production by the kidneys.
More Information
In chronic kidney disease, the kidneys' ability to produce erythropoietin is impaired, leading to decreased red blood cell production and anemia.
Tips
It is a common mistake to immediately jump to iron studies when evaluating anemia, but in the context of chronic kidney disease, erythropoietin deficiency is the more likely cause.
Sources
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