Fig. 1.

Evaluation and management of anemia.

Once the blood count demonstrates anemia, an evaluation should begin with an assessment of iron status. When ferritin and/or iron saturation levels indicate absolute iron deficiency, iron therapy is indicated. When ferritin and/or iron saturation values rule out absolute iron deficiency, serum creatinine and glomerular filtration rate (GFR) determination may indicate chronic kidney disease (CKD). When ferritin and/or iron saturation values are in determinant, further evaluation to rule out absolute iron deficiency versus inflammation/chronic disease is necessary. A clinical response to a therapeutic trial of iron would confirm absolute iron deficiency. No response to iron therapy would indicate the anemia of chronic disease, suggesting that ESA therapy be considered.

Reproduced with permission From Goodnough LT, Schrier A. Am J Hematol 2014;89:88–96 [4].