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Retired NBME 18 Answers

nbme18/Block 4/Question#22 (reveal difficulty score)
A 67-year-old man comes to the physician ...
Erythropoietin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—ootscoot(34)
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This guy has a normocytic anemia with evidence of kidney damage (increased Cr). According to UW, CKD can be assumed in a patient with high Cr and uncontrolled hypertension (which is evident in this dude that hasn't been to the doctor in years and has a 150/98 BP).

Also straight from UW: CKD is commonly associated with normocytic anemia 2/2 reduced production of EPO by the kidneys. Therefore, the most appropriate therapy is erythropoietin.

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dhkahat  how do we know when to transfuse? +2
destinyschild  I also thought about transfusing, but then thought that might cause iron overload since he's also getting iron supplements. I'm not sure if iron overload is a possibility w EPO. Please correct me if I am wrong +
drjo  Transfusion is only indicated when hemoglobin is < 7g/dL & this tx is usually reserved for critically ill patients +5



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