A 30-year-old woman with systemic lupus erythematosus treated with high-dose prednisone comes to her physician with symptoms of anemia. The patient’s blood studies show a low hemoglobin level (10 g/dL), a low serum iron level, an elevated ferritin level, and a low total iron-binding capacity with normocytic RBCs on blood smear.Which of the following is the most appropriate treatment for this patient’s anemia?

Erythropoietin

9. The correct answer is A. This patients clinical presentation is consistent with anemia of chronic disease (ACD) in the setting of systemic lupus erythematosus. ACD presents with low serum iron levels, elevated ferritin levels, decreased total iron-binding capacity, and microcytic/ normocytic RBCs on blood smear. ACD resolves if the underlying condition is corrected, but in the absence of a successful primary treatment, erythropoietin can be effective in treating the anemia. Iron therapy is not effective in treating this disorder. Answer B is incorrect. Iron therapy is inappropriate in treating anemia of chronic disease, since iron stores are not low. Answer C is incorrect. Folate supplementation would be appropriate in macrocytic anemia caused by folate deficiency. Answer D is incorrect. Parenteral vitamin B12 therapy is appropriate for pernicious anemia caused by lack of intrinsic factor, which is necessary for vitamin B12 absorption. Answer E is incorrect. Phlebotomy is appropriate in treating cases of iron overload, as seen in patients with chronic transfusion therapy and hemochromatosis.