Hypoproliferative
AnemiaThis normocytic normochromic anemia develops when erythropoietin
(=EPO) is not produced enough by the kidney tissue and the bone marrow does not
produce enough red blood cells because of the lack of the EPO stimulus. The most common causes for this is kidney failure.
This can be brought about from kidney
diseases where the kidney function is reduced. When there is reduced
kidney function with a creatinine clearance below 45 ml per minute, anemia occurs
because EPO production decreases. Two disease processes that lead to severe anemia
are amyloidosis and diabetic nephropathy. General starvation with protein deficiency
will also lead to hypoproliferative anemia by a mechanism that is not fully understood.
Symptoms These are the same as the general symptoms
of lassitude, lack of energy and other symptoms described in the introductory
chapter to anemia. On top of this there are the symptoms associated with the kidney
failure. There may be high blood pressure and fluid retention. Diagnostic
tests There are the laboratory findings of kidney failure with
a high BUN, creatinine and a reduced creatinine clearance. In addition there is
a low reticulocyte count, fragmentation of RBC’s in the peripheral blood smear
and a lack of RBC precursor cells in the bone marrow. Treatment Treatment consists of normalizing
the kidney function as much as this is possible, if necessary with dialysis. EPO
treatment is also given starting with a lower dose of 50 to 100 units per kilogram
intravenously or subcutaneously three times per week. In addition iron supplements
are given (induction dose). After 8 to 12 weeks the maximum response in terms
of increasing the RBC level is reached. Maintenance doses are about half of the
induction doses. Transfusions are rarely needed.
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