Which test(s) should be performed to determine whether the anemia is related to chronic disease or iron deficiency, and what would those results show?

A CBC should be ordered which will give values of RBC’s, MCV and MCH along with MCHC (Dunphy et al., 2022). With a hemoglobin of less than 13 g/dL and hematocrit of 29 %both Anemia of Chronic Disease and Iron Deficiency Anemia could be considered. If the patient’s MCV is between 50-80, the MCH between 12-25 and the MCHC of 25-30 the patient would likely have iron deficiency anemia or Microcytic/hypochromic (Dunphy et al., 2022). If the patient’s MCV is less than 80, MCH 20-25 and MCHC of 27 than the patient likely has Anemia of Chronic disease or microcytic, normochromic (Dunphy et al., 2022). In addition, with Iron Deficiency Anemia obtaining a serum ferritin level and TIBC would be indicated. The ferritin level will be lower and the TIBC higher (Dunphy et al., 2022). In Anemia of Chronic Disease obtaining a iron studies and you will see a low iron level and a low TIBC and normal or elevated ferritin levels (Dunphy et al, 2022).

Should the practitioner consider a blood transfusion for this patient? Explain your answer

At this point I would not consider a blood transfusion. Patients would need to be hospitalized for the treatment and the benefits of this would be short term (Wiciński et al., 2020). Rather, treatment of the underlying cause would be more beneficial to the patient.

Which medication(s) should be considered for this patient? Provide exact prescription details

To maximize absorption, I would prescribe IV iron:

Iron Sucrose 200 mg IV for 5 doses in over 14 days (cumulative 1000 mg in 14 day period

I would also recommend the patient receive Epoetin Alfa at the lowest recommended dose (Dunphy et al., 2022).

What considerations should the practitioner include in the care of the patient if an erythropoietic agent is used for treatment? What risk are involved with the use of erythropoietic agents?

Providers should be aware of past medical history for the patient including if they have uncontrolled hypertension, any excessive sensitivities to mammalian cell-derived products or albumin. Providers also need to be aware that these agents do put patients more at risk for clotting disorders and CHF (Patel & Patel 2023).

What follow up should the practitioner recommend for the patient?

Because a erythropoietin agent is being used the patient should have their hemoglobin checked twice weekly for 2-6 weeks (Dunphy et al., 2022). Follow up care will be with their primary care team to determine a cause for the anemia, start treatment and refer to a specialty if indicated (Dunphy et al., 2022).

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