A 62-year-old man was admitted to the intensive care unit 7 days ago for severe sepsis requiring mechanical ventilation and vasopressor support. His condition has stabilized: he was extubated yesterday, vasopressors were discontinued, and his central venous catheter was removed this morning. His hemoglobin is 7.8 g/dL today (baseline 13.5 g/dL), down from 8.2 g/dL yesterday. He received 2 units of packed red blood cells on ICU day 3 when his hemoglobin was 6.5 g/dL. Daily laboratory draws have been frequent throughout his stay. He is scheduled to transfer to the general medical floor tomorrow. Which of the following is the highest priority intervention to mitigate ongoing anemia as he transitions out of the ICU?

A 68-year-old man with septic shock admitted 5 days ago is now clinically stable and afebrile for 24 hours in the ICU. He received 2 units of packed red blood cells (PRBCs) when his hemoglobin (Hb) dropped to 6.2 g/dL on admission. Current labs: Hb 7.8 g/dL, Hct 23.5%, WBC 9.2 × 10^3/µL, platelets 180 × 10^3/µL; lactate has normalized. He has no active bleeding, hypoxemia, or myocardial ischemia. De-escalation of supportive therapies is being considered. What is the MOST appropriate next step regarding his red blood cell transfusion support?

A 62-year-old man with acute respiratory distress syndrome (ARDS) is mechanically ventilated and requires a norepinephrine infusion via a central line to maintain a mean arterial pressure >65 mmHg. His medical history is notable for well-controlled hypertension. Over the past 24 hours, his hemoglobin has decreased from 8.2 g/dL to 7.1 g/dL. He is hemodynamically stable, with a heart rate of 88/min and blood pressure of 110/70 mmHg. He is sedated, with an SpO₂ of 96% on an FiO₂ of 0.5, and shows no signs of active bleeding or tissue hypoxia. Blood conservation measures, including the use of pediatric phlebotomy tubes, are in place. Given this patient’s presentation, which of the following is the most appropriate immediate management step?

A 62-year-old man is in the intensive care unit receiving a stable low-dose norepinephrine infusion via a right internal jugular central line. He was admitted 5 days ago for severe sepsis from a urinary source, which is now resolving. His most recent lactate is 1.2 mmol/L. Over the past 24 hours, his hemoglobin has trended down from 8.5 g/dL to 7.2 g/dL. He is afebrile, heart rate 88 bpm, blood pressure 118/72 mmHg, and respiratory rate 16 breaths/min. He denies chest pain or dyspnea and has no signs of active bleeding. His cardiac history includes well-controlled hypertension. Given this patient’s stable clinical status and laboratory values, which hemoglobin threshold is MOST appropriate to guide red blood cell transfusion?

A 45-year-old man is recovering in the intensive care unit two weeks after admission for multiple long bone fractures and a splenic laceration. He is on pressure support ventilation with minimal oxygen requirements, has a femoral central venous catheter, and is tolerating oral intake. His hemoglobin is 7.5 g/dL, down from 8.2 g/dL yesterday, but he remains hemodynamically stable and afebrile. His reticulocyte count is low. The care plan focuses on de-escalating interventions as he continues to stabilize. Which of the following interventions is most appropriate to manage this patient’s anemia while supporting care de-escalation?

A 62-year-old man is in the medical ICU on day 5 of admission for severe sepsis secondary to pneumonia complicated by acute kidney injury and shock. He has a history of hypertension and stage 3 chronic kidney disease. On admission, he was hypotensive requiring norepinephrine; now he is afebrile, heart rate is 90 bpm, blood pressure is 110/75 mm Hg off vasopressors for 24 hours, respiratory rate is 20 /min on pressure support ventilation with FiO₂ 0.40, and SpO₂ is 96%. Laboratory studies show creatinine 1.5 mg/dL (baseline 1.3), mild transaminase elevation, normal bilirubin, and iron studies consistent with anemia of inflammation (ferritin elevated, TIBC low). He has had approximately 80 mL of blood drawn daily for labs. His hemoglobin was 9.2 g/dL on admission, fell to 6.5 g/dL on day 2 (for which he received 2 units PRBCs), and is now 7.8 g/dL. Given his improving clinical status and current hemoglobin, which of the following is the highest priority intervention to manage his ongoing anemia?

A 62-year-old patient is recovering in the telemetry unit after a prolonged ICU stay for severe sepsis. The patient was recently extubated and is on 2 L/min of oxygen via nasal cannula. The central venous catheter was removed yesterday, and vasopressors were discontinued over 24 hours ago. Morning labs show hemoglobin (Hb) 7.5 g/dL. During rounds, the patient is alert and oriented with no dyspnea, chest pain, or signs of active bleeding. Given this patient’s clinical status, what is the most appropriate next step in managing their anemia?

A 65-year-old man with a history of stable coronary artery disease was admitted to the ICU for severe sepsis secondary to pneumonia, complicated by multi-organ dysfunction. He has been weaned off vasopressors for 24 hours and is now hemodynamically stable (BP 120/75 mmHg, HR 88 bpm), afebrile, and on pressure support ventilation (PSV 10 cm H₂O, PEEP 5 cm H₂O, FiO₂ 30%) with SpO₂ 96%. His lactate has normalized, and there is no evidence of active bleeding or new myocardial ischemia. His hemoglobin is 6.8 g/dL, down from 7.5 g/dL yesterday. Which of the following is the MOST appropriate next step in managing his anemia?

A 68-year-old man is admitted to the medical intensive care unit for septic shock. He is intubated on assist-control ventilation and receiving a continuous norepinephrine infusion via a central line. His history is significant for hypertension and type 2 diabetes. Over the past 48 hours, his hemoglobin has trended downward from 9.2 g/dL to 7.3 g/dL. Current vital signs are: heart rate 88 bpm, blood pressure 110/65 mmHg (norepinephrine 0.05 mcg/kg/min), respiratory rate 16 breaths/min, and SpO₂ 98% on FiO₂ 0.4. A recent lactate level is 1.8 mmol/L. There are no signs of active bleeding. Given this presentation, which of the following is the most appropriate initial management step for his anemia?

A 72-year-old man with stage 4 chronic kidney disease (baseline creatinine 2.5 mg/dL) and NYHA Class III heart failure is admitted to the intensive care unit with acute decompensated heart failure. Over the past 48 hours, his hemoglobin has declined from 9.2 g/dL to 7.8 g/dL without any overt bleeding. He is euvolemic on exam, denies dizziness or dyspnea at rest, and has stable vital signs (BP 118/72 mmHg, HR 88 bpm, RR 16 breaths/min, SpO₂ 96% on room air). His current creatinine is 2.8 mg/dL, BNP is 1200 pg/mL, and reticulocyte count is 1.0% with no evidence of hemolysis. What is the most appropriate initial management strategy for his anemia?