CDN Anemia Management in Dialysis Patients 3

Question 1

What is the primary mechanism by which erythropoiesis-stimulating agents (ESAs) treat anemia in dialysis patients?

Accepted Answer

Binding to EPO receptors on erythroid progenitors to stimulate red blood cell production

Answer

Increasing intestinal absorption of dietary iron

Answer

Inhibiting the destruction of mature red blood cells in the spleen

Answer

Increasing hemoglobin oxygen-carrying capacity per red cell

Question 2

Which of the following best describes functional iron deficiency in dialysis patients?

Accepted Answer

Normal or elevated ferritin with low TSAT indicating inadequate iron mobilization

Answer

Low serum ferritin with low TSAT

Answer

High ferritin with high TSAT indicating iron overload

Answer

Low ferritin with high TSAT from recent IV iron infusion

Question 3

A large clinical trial (TREAT) showed that targeting hemoglobin levels above 13 g/dL with ESA therapy in CKD patients significantly increased the risk of which adverse outcome?

Accepted Answer

Stroke and cardiovascular events

Answer

Severe hyperkalemia

Answer

Dialysis-related hypotension

Answer

Peritoneal membrane failure

Question 4

A dialysis patient has Hgb 9.6 g/dL, TSAT 26%, and ferritin 680 ng/mL while receiving ESA therapy. What is the most appropriate next step?

Accepted Answer

Investigate other causes of anemia such as occult bleeding, folate/B12 deficiency, or inflammation

Answer

Increase the ESA dose by 25%

Answer

Initiate IV iron therapy immediately

Answer

Order a packed red blood cell transfusion

Question 5

Which diagnostic test is used to confirm the presence of anti-erythropoietin antibodies when pure red cell aplasia (PRCA) is suspected in a dialysis patient?

Accepted Answer

Anti-EPO antibody assay (ELISA)

Answer

Direct Coombs (antiglobulin) test

Answer

Flow cytometry of peripheral blood

Answer

Peripheral blood smear review

Question 6

Which of the following nutritional deficiencies, when present in a dialysis patient, can blunt the response to ESA therapy by impairing DNA synthesis in erythroid precursors?

Accepted Answer

Vitamin B12 (cobalamin) deficiency

Answer

Vitamin A deficiency

Answer

Zinc deficiency

Answer

Magnesium deficiency

Question 7

During hemodialysis, a nurse notes the patient's blood in the extracorporeal circuit appears unusually dark. The patient denies symptoms. The hemoglobin drawn pre-treatment was 11.2 g/dL. What is the most likely explanation?

Accepted Answer

Adequate hemoglobin with normal venous oxygen saturation

Answer

Hemolysis from dialyzer reaction causing bright red lysed blood

Answer

Normal venous blood appearance due to high oxygen extraction by tissues

Answer

Iron deficiency causing hypochromic red cells that appear darker