If hemoglobin increases by more than 1.0 unit in less than 2 weeks, what should be done?

When there is an increase in hemoglobin levels by more than 1.0 unit in less than 2 weeks, it indicates a potentially excessive response to erythropoiesis-stimulating agents (ESA). A rapid rise in hemoglobin can increase the risk of adverse effects, including thromboembolic events, as it can lead to overly high levels of hemoglobin that may compromise blood flow and oxygen delivery.

In this context, it's critical to manage the ESA therapy to ensure patient safety. Decreasing the ESA dose is the appropriate response in order to achieve a more gradual and controlled rise in hemoglobin, thereby minimizing any potential risks associated with a rapid increase. This change helps to maintain hemoglobin levels within a target range that is safe and effective, without encouraging sudden fluctuations that could lead to increased morbidity.

Other options like increasing the ESA dose would exacerbate the problem by promoting further increases in hemoglobin, while continuing the same dose could also lead to the same risk. Switching to a different medication might not address the immediate concern of the increased hemoglobin levels and would complicate the management. Therefore, reducing the ESA dose is the best approach in this scenario.