Download Anemia of Chronic Renal Failure

Anemia of Chronic
Renal Failure
Etiology
1. Metabolic Red Blood Cell
Dysfunction
2. Decreased Erythropoietin
production
3. Hemolytic Ureamic Syndrome
4. Marrow Suppression ( ureamic
inhibitors )
Metabolic Red Cell Dysfunction
1. ATP is high possibly due to a high serum phosphate
2. 2,3 DPG is increased in response to anemia and
hyperphosphatemia
3. ATPase, Na-K pump are decreased in ureamia and resulting
in shortening life span (more rigidity and cell shape changes),
HMP decreased response renders excessively sensitive to
Oxidant drugs and Chemicals
(เช่น พวกกลูตาไธโอนจะลดการทางานลง)
Glucose
G-6-PD
Glucose-6-Phosphate
NADP
GSH
Lactate (EMP)
6-Phosphoglycerate (HMS)
NADPH
GSSG
Decreased Erythropoietin
(EPO) Production
1. Glycoprotein MW 36,000
daltons.
2. Eschbach showed that the
patient with renal failure even
there was anemia but normal
EPO level. However, it was
lower than the anemia from
other causes.
Hemolytic Ureamic Syndrome
1. Pathology of renal endothelial cell forming
fibrin clot and platelet thrombi resulting in
microangiopathic hemolytic anemia
2. Decreased platelet mass, mildly lower platelet
count and MPV
3. Reduced platelet adhesion such as high
molecular weight multimers of von Willebrand
are reduced, GP Ib has been reported to be
defective
4. Defective platelet activation and aggregation
(reduced synthesis of thromboxane A2). Platelet
functions defected due mainly to toxic
Marrow suppression (Ureamic
inhibitors)
1. Experiment found that serum from
ureamic patient can suppress the growth
of CFU-E and burst forming uniterythroid ( BFU-E)
2. After hemodialysis or continuous
ambulatory peritoneal dialysis can
increase Hb level. Anyway, hemodyalysis
may cause iron and folate deficiency.
Hyperthyroidism
1. Hyperparathyroidism is a complicated condition in
renal failure
2. Increased PTH resulting in suppression of RBC
production in BM
1.
2.
3.
4.
5.
6.
Anemia of endocrine
disorder
Anemia of Pituitary deficiency
Anemia of thyroid dysfunction
Anemia of adrenal dysfunction
Anemia of gonadal dysfunction
Anemia of pregnancy
Anemia of parathyroid dysfunction
Anemia of pituitary deficiency
1. Hypophysectomy in animal causes severe erythroid hypoplasia and
anemia (เพราะขาด GH)
2. It has been proposed that the pituitary gland produces a specific
erythropoietic hormone
3. Growth hormone has been shown to be capable of stimulating red cell
production in vitro
4. It has been claimed that hypothalamic injury may affect erythropoietin
release, the rate of red cell production or both
5. Hypophyseal dysfunction is often associated with leukopenia and a
normochromic, normocytic anemia (ขาด GH การผลิตลดลง)
6. The red cell life span is normal and relative marrow failure
Anemia of Thyroid dysfunction
1. Kocher reported that thyroidectomy is followed by a reduction in the red
cell count
2. Anemia is normocytic, microcytic, macrocytic
3. Lack of thyroid hormone is complicating of iron, Vitamin B12, folic acid
4. T3, T4 potentiate the effect of erythropoietin on the formation of
erythroid colonies
5. Many hypothyroid patients have a hypoplastic anemia ( Hb 8 – 9
g/dl)
6. Normochromic, normocytic anemia is the characteristic form of
hypothyroidism
Anemia of Adrenal Dysfunction
1. Adrenalectomy in animal causes a mild anemia and respond
to therapy with adrenal glucocorticoid or erythropoietin
2. Normochromic, normocytic anemia has been observed
(เพราะขาดการกระตุน้ แต่ไม่มปี ั จจัยอื่น)
1. The erythropoietic effect of ACTH or adrenal cortical hormone
are unclear
1.
Anemia of Gonadal
Dysfunction
Androgens
extensively utilized in the
treatment of patients with various types
of refractory anemia. It has been shown
to stimulate red cell production by
increasing the production of
erythropoietin (ฮอร ์โมนชายกระตุนอี
้ โป้ )
2. Castration of animal causes a decrease in
the rate of red cell production until the
Hb and red cell volume stabilized at
levels the same as those of the normal
female
3. Right now the recombinant human
Anemia of Pregnancy
1. Anemia in pregnancy is thought due to
changes in hormonal environment
2. In mice even progressive decrease in the Hct,
the red cell volume, erythropoietin secretion
and rate of red cell production increase during
pregnancy. Placental lactogen may in part be
responsible for the erythropoietic stimulation.
3. In human, anemia is aggravated by dietary
restrictions resulting in iron deficiency
sometimes folic acid deficiency
4. Anemia will be manifested about the 8 th wk
progresses slowly until the 32-34 wk. This is so-
Anemia of Parathyroid
Dysfunction
1. Anemia in hyperparathyroidism will
disappear after parathyroidectomy
2. Parathyroidectomy in renal disease
results in some improvement in the
anemia
3. One report says that parathyroid
hormone can suppress normal red cell
production but in fact these hormones
may cause either renal calcification
resulting in reduction of erythropoietin
formation or marrow sclerosis resulting