If hemoglobin is greater than 12 g/dL, what is typically done?

• A. Hold ESA
• B. Increase ESA dose
• C. Discontinue iron therapy
• D. Start dialysis

Answer: (A)

When hemoglobin climbs above the safe range, the goal is to prevent excessive red blood cell production and its risks. Holding the erythropoiesis-stimulating agent gives the body a chance for Hb to come down toward the target without pushing it higher. Continuing or increasing ESA therapy at this point could raise the risk of thrombosis, hypertension, and other complications from too-high Hb. After the Hb level falls back toward the goal, you can reassess and adjust the ESA dose downward rather than back up. Iron therapy isn’t automatically stopped or started based on a high Hb alone, and starting dialysis isn’t a management step for this scenario.