Which of the following drugs would be most appropriate to treat the patient‚Äôs anemia? A 45-year-old man presented to the hospital for a control visit. The man had been on ambulatory hemodialysis for three months for end stage renal failure. Pertinent lab values on admission were:
RBC count: 3.4 x 106/ mm3¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬† ¬†(normal: 4-5.5)
Reticulocytes: 0.01% of red cells¬†¬†¬†¬†¬†¬†¬† (normal 0.5-1.5%)
MCV: 92 m3¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†¬†(normal: 80-100) Hb: 9 g/dL (normal: > 12)
Serum iron: 90 g/dL¬†¬†¬†¬†¬†¬†¬†¬† (normal 50-160)
A. Folic acid B. Cyanocobalamin C. Deferasirox D. Ferrous fumarate E. Epoetin beta
Epoetin beta-e is the correct answer. the history of the patient suggest that he his most likely suffering from a hypoproliferative anemia due to renal insufficiency. in patients on long term dialysis increased erythropoiesis occurs but rarely reverts to normal. this disease is a normochromic-normocytic anemia with peripheral reticulocytopenia, like in the present case. the cause of the anemia is complex but involves reduced erythropoietin production and a shortened erythrocyte life span. since erythropoietin is secreted in the kidney in response to anoxia and is responsible for normal differentiation of rbc from other stem cells, recombinant erythropoietin is used to treat anemia in patient with end stage renal disease who are undergoing hemodialysis. iron supplements must also be given to achieve an adequate erythropoietin response. patients under hemodialysis can develop folic acid deficiency since folates are removed from the plasma during the dialysis procedure, but the anemia of the patient is not a megaloblastic anemia.