Anemias USMLE Step 1 Practice Question
A 64-year-old man with a 12-year history of type 2 diabetes mellitus and hypertension presents to the clinic with progressive fatigue and dyspnea on exertion over the past 3 months. He denies melena, hematochezia, or heavy menstrual bleeding. Vital signs are stable: BP 148/92 mmHg, HR 98 bpm, RR 18/min, SpO2 98% on room air. Physical examination reveals no pallor of mucous membranes, no jaundice, and no hepatosplenomegaly. Laboratory results: hemoglobin 9.5 g/dL, MCV 87 fL, reticulocyte count 1.1%, serum iron 65 mcg/dL, ferritin 312 ng/mL, TIBC 240 mcg/dL, creatinine 2.9 mg/dL, eGFR 21 mL/min/1.73mĀ², and urinalysis showing 2+ proteinuria. Peripheral blood smear shows normocytic red blood cells without schistocytes, spherocytes, or polychromasia. Which of the following is the most likely etiology of this patient's anemia?
Answer choices
- AAnemia of chronic disease secondary to poorly controlled diabetes
- BAnemia of chronic kidney disease with inadequate erythropoietin productionCorrect answer
- CIron deficiency anemia from occult gastrointestinal bleeding
- DHemolytic anemia secondary to diabetic microangiopathy
- EVitamin B12 deficiency from diabetic gastroparesis
- FThalassemia trait unmasked by renal failure
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