If hemoglobin (Hgb) increases by less than 1.0 unit in 4 weeks, what should be done?

When assessing the management of hemoglobin levels in patients receiving Erythropoiesis-Stimulating Agents (ESA), an increase of less than 1.0 unit in 4 weeks indicates a suboptimal response to the treatment. In such a case where hemoglobin hasn't increased sufficiently, the appropriate course of action is to increase the dose of the ESA.

This is because the goal of ESA therapy is to help patients achieve a target hemoglobin level, which would usually be in the range that maintains adequate red blood cell counts while minimizing the risks associated with anemia. An increase in dosage can help stimulate more effective erythropoiesis, which is necessary to improve hemoglobin levels more significantly within the treatment timeframe.

Monitoring hemoglobin levels alone may not be sufficient if there is a chronic under-response to treatment, and changing the treatment plan entirely may not be warranted immediately; instead, adjusting the current dosage is typically the first step to optimize the patient’s response to ESA therapy.