A 66-year-old woman with stage 3 chronic kidney disease presents with progressive fatigue and decreased exercise tolerance. Vital signs: BP 148/92, HR 88, RR 16, Temp 37.2°C, SpO2 98%. Laboratory studies reveal normocytic anemia (Hgb 8.2 g/dL) with low reticulocyte count (0.5%), normal iron studies, and creatinine 2.1 mg/dL. She denies melena or hematochezia. Which of the following is the most likely cause of her anemia?
- A)Autoimmune hemolysis with splenic sequestration
- B)Loss of intrinsic factor from parietal cell destruction
- C)Defective globin chain synthesis due to iron lack
- D)Deficient folate absorption in the jejunum
- E)Decreased erythropoietin production by the kidneyGABARITO
Explicação
The kidney produces erythropoietin in response to hypoxia, and chronic kidney disease reduces this signal, causing a hypoproliferative normocytic anemia. The low reticulocyte count and normal iron studies fit erythropoietin deficiency. Ver explicação completa e trilha adaptativa →