Approach to anemia (underproduction) Quiz: Ace Your Exams
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A 65-year-old man presents to the primary care clinic for his routine visit. In the past six months, he has noticed fatigue, diffuse itchiness, and decreased urine production. He has a 20-year history of diabetes and has not seen a doctor since he lost insurance coverage six years ago. He has not had blood in the stool. Temperature is 36.1°C (97°F), pulse is 88/min, respiratory rate is 15/min, and blood pressure is 175/95 mmHg. On physical examination, he has conjunctival pallor and 1+ pitting edema in both lower extremities up to the knees. Cardiopulmonary and abdominal examinations are unremarkable. Results of laboratory testing are shown below. Which of the following is the best next step for determining the cause of anemia in this patient?
| Laboratory value | Result |
| Hemoglobin | 9.4 g/dL |
| Hematocrit | 28% |
| Mean corpuscular volume | 85 fL |
| Reticulocyte count | 0.4% |
| Sodium | 134 mEq/L |
| Potassium | 5.3 mEq/L |
| Blood urea nitrogen | 77 mg/dL |
| Creatinine | 6.3 mg/dL (previously 1.7 mg/dL) |
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