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:

1. 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?
2. Should the practitioner consider a blood transfusion for this patient? Explain your answer.
3. Which medication(s) should be considered for this patient?
4. What considerations should the practitioner include in the care of the patient if erythropoietic agents are used for treatment?
5. What follow-up should the practitioner recommend for the patient?

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