Anemias Overview

A 52-year-old man with a 20-year history of chronic kidney disease (eGFR 18 mL/min/1.73m²) presents with hemoglobin of 7.8 g/dL. His reticulocyte count is 0.8% (normal 0.5–2%), and peripheral blood smear shows normocytic normochromic RBCs. Iron studies and vitamin B12/folate levels are normal. Which investigation is most specific for confirming the diagnosis of anemia of chronic kidney disease?

A 38-year-old woman presents with fatigue and dyspnea on exertion. On examination, she has pallor and glossitis. Her hemoglobin is 8.5 g/dL with microcytic hypochromic indices (MCV 68 fL, MCH 22 pg). Serum iron is low, TIBC is elevated, and ferritin is 12 ng/mL. Which investigation is most appropriate to confirm the diagnosis and identify the underlying etiology?

A 35-year-old woman from rural India presents with severe anemia (hemoglobin 5.8 g/dL), glossitis, paresthesias, and megaloblastic changes on bone marrow examination. Serum vitamin B12 is 120 pg/mL (normal >200). What is the drug of choice for her condition?

A 42-year-old man with a 10-year history of rheumatoid arthritis and a 5-year history of chronic kidney disease (eGFR 35 mL/min/1.73 m²) presents with hemoglobin 9.2 g/dL and normocytic indices. Serum iron and ferritin are normal. What is the most common cause of anemia in this patient?

A 38-year-old woman from rural India presents with fatigue, dyspnea on exertion, and glossitis. Laboratory studies show hemoglobin 7.2 g/dL, MCV 72 fL, serum B12 level 150 pg/mL (normal >200), and serum folate 2.8 ng/mL (normal >5.4). Peripheral blood smear shows hypersegmented neutrophils and target cells. All of the following would be expected findings in this patient EXCEPT: