MEDizzy - A 62 year old man with stage 3 CKD (eGFR 39 mL/min/1.73 m2

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Nephrology and urology

A 62 year old man with stage 3 CKD (eGFR 39 mL/min/1.73 m2 ) is noted to have haemoglobin of 79 g/L, white cell count 8.9×109 /L; platelet count 146×109 /L; mean corpuscular volume (MCV) 76 fL. What is the most appropriate investigation?

ExplanationWhile erythropoietin (EPO) deficiency is common in patients with chronic kidney disease, the haemoglobin level here is disproportionately low for this level of renal failure. Haemoglobin <10 g/L is not usually observed until stage 4 CKD. Serum EPO levels may be difficult to interpret in this context, although if they are low or indeed normal, this is inappropriate in the context of anaemia and makes renal EPO insufficiency more likely. The MCV is low, indicating potential iron rather than folate deficiency, and white cell and platelet counts are normal, rendering a bone marrow problem or hypersplenism less likely.