In Three Months, His Repeat Hemoglobin Level Is 19

In three months, his repeat hemoglobin level is 19.0 g/dL.  His oxygen saturation in the office is 95% on room air.  His carboxyhemoglobin level is normal and serum erythropoietin level is elevated.  Iron studies and serum folate and vitamin B12 levels are all normal.  Urinalysis shows no blood, no RBCs, and trace protein.  Which of the following is the best next step in managing this patient?

A) Bone marrow biopsy
B) Hemoglobin electrophoresis
C) JAK2 mutation testing
D) Nocturnal oximetry
E) Phlebotomy and re-assessment in 3 months

Correct Answer:

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