A 35-year-old female patient with a history of chronic kidney disease is being transported to a higher-level care facility. She presents with pallor, fatigue, and shortness of breath. Labs show a hemoglobin level of 7 g/dL and a hematocrit of 21%. During transport, what is the most appropriate immediate intervention?
Start intravenous iron therapy
Administer diuretics for symptom relief
Transfuse 1-2 units of packed red blood cells (PRBCs)
In a patient with symptomatic anemia and a hemoglobin level below 8 g/dL, particularly one with chronic kidney disease, transfusion of packed red blood cells (PRBCs) is often indicated. This is to rapidly increase the oxygen-carrying capacity of the blood and alleviate symptoms. Administering erythropoietin can be beneficial in the long term for chronic management, but it is not effective for acute symptom relief. Initiating the patient on intravenous iron is also more suited for long-term management as it does not address acute symptoms. Administering diuretics alone will not address the underlying issue of anemia and can potentially worsen the patient’s symptoms by causing hypovolemia.
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