In Three Months, His Repeat Hemoglobin Level Is 19

question 996

Multiple Choice

In three months, his repeat hemoglobin level is 19.0 g/dL.  His oxygen saturation in the office is 95% on room air.  His carboxyhemoglobin level is normal and serum erythropoietin level is elevated.  Iron studies and serum folate and vitamin B12 levels are all normal.  Urinalysis shows no blood, no RBCs, and trace protein.  Which of the following is the best next step in managing this patient?

• A)Bone marrow biopsy
• B)Hemoglobin electrophoresis
• C)JAK2 mutation testing
• D)Nocturnal oximetry
• E)Phlebotomy and re-assessment in 3 months

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Definitions:

Henry Murray

An American psychologist known for his theory of personality and development of the Thematic Apperception Test.

Theorizing

Formulating theories or systematic ideas about how certain aspects of the world work, often based on observation, experimentation, and reasoning.

Psychogenic Need

A term referring to emotional or psychological needs that influence an individual's mental health and behavior, rather than physical needs.

Basic Elements

Fundamental components or building blocks that form the basis or essentials of a larger system, concept, or structure.