American Board of Family Medicine (ABFM) Practice Exam

What treatment is indicated for a patient with chronic kidney disease (CKD) exhibiting low ferritin, hemoglobin, and hematocrit with MCV less than 80?

1. Vitamin B12 injections

2. Iron supplement

3. Folic acid supplementation

4. Transfusion therapy

The correct answer is: Iron supplement

The indicated treatment for a patient with chronic kidney disease (CKD) demonstrating low ferritin, hemoglobin, and hematocrit levels along with a mean corpuscular volume (MCV) of less than 80 suggests the presence of iron deficiency anemia. In the context of chronic kidney disease, anemia is quite common due to several factors. One major contributor is the reduced production of erythropoietin (EPO) by the kidneys, leading to decreased red blood cell production. Additionally, iron deficiency can occur due to impaired absorption or increased demands for iron in the setting of ongoing blood loss or nutritional deficiencies. The low ferritin level indicates depleted iron stores, which is critical since ferritin is a marker of the body's iron reserves. The low hemoglobin and hematocrit reinforce the diagnosis of anemia. The low MCV further signifies microcytic anemia, which is typical in iron deficiency. In this case, iron supplementation is the appropriate treatment to replenish iron stores, enhance hemoglobin production, and subsequently improve the patient's anemia. Oral iron supplements or intravenous iron may be utilized, depending on the severity of the deficiency and the patient's ability to tolerate oral supplements. Other treatment options listed, such as vitamin B12 injections or folic acid