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| Image Source ADAM |
Causes:
• decreased RBC (red blood cell) production
• loss of functioning renal tissue (decreased EPO production)
• vitamin deficiencies
• iron deficiency
• aluminum toxicity
• blood loss
• abnormal bleeding
• lab sampling
• loss in dialyzer
• red blood cell (RBC) destruction
• hemolysis during dialysis treatment
• hemolytic anemia
• Lupus, sickle cell
• bleeding abnormalities; prolonged bleeding
• decreased number of platelets and platelet defects
• severe anemia
• Heparin therapy during hemodialysis
• medications that decrease platelet adhesiveness
Symptoms:
• Severe fatigue
• Shortness of breath
• Weakness
• Dizziness
• Mental confusion
• Feeling cold all the time
• Pallor (pale skin, gums, and nail beds)
Anemia in CKD is associated with a heart problem called left Veniricular Hyperthrophy (LVH). which is one of the leading causes of death in people with kidney disease.
• Recombinant human erythropoietin (Eprex, Neo-Recormon, Procrit, EPOGEN) or darbcpoietin (Aranesp) with increased half-life and activity.
• Given sub-cuteneous (pre-D and PD) or IV (HD)
• Stimulates RBC production by bone marrow
• Pt must be iron repleted for these drugs to work efficiently : major cause of resistance to EPO therapy
• Other causes of resistance :
- inflammation (infection, cancer, ..)
- Pure Red Cell Aplasia (antibodies against EPO seen with SC Eprex)
Hemoglobin
• Chemical to which oxygen and carbon dioxide bind for transport
• Carries oxygen and carbon dioxide between lungs and tissues
• Normal hemoglobin
• Men- 14.4-16.6 g/dL
•Women 12.7- 14.7 g/dL
• NKF-KDOQ1™ Target hemoglobin for dialysis patients 11-12 g/dL for men and women.
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