Skill Checkup: A 59-Year-Old Man With a 4-Year History of Non-Dialysis Chronic Kidney Disease Presents With Anemia

Vecihi Batuman, MD, FASN


September 09, 2022

Erythropoietic proliferative activity can be effectively measured via absolute reticulocyte count. This is a laboratory test that is vital in the evaluation of anemia of chronic illness or CKD, per Colbert and colleagues. However, EPO levels are not typically used to differentiate EPO deficiency from other causes of anemia in patients with CKD.

In the setting of CKD with iron deficiency anemia, abnormalities of the white blood cell count and differential or platelet count are atypical and should prompt clinical suspicion for other conditions in the differential. In addition, reticulocyte count may be low in hypoproliferative erythropoiesis with anemia.

Generally, assessment and management of iron deficiency anemia in CKD are different from anemia in the noninflammatory setting, as the usual biomarkers for anemia are limited. Workup approaches comprise complete blood cell count, which should include Hgb concentration, red cell indices, white blood cell count and differential, and platelet count; absolute reticulocyte count; serum ferritin level; TSAT; and serum vitamin B12 and folate levels.


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