Page 400 - Essential Haematology

386 / Chapter 28 Haematological changes in systemic disease

Figure 28.4 Peripheral blood fi lm

in chronic renal failure showing
red cell acanthocytosis and
numerous ‘ burr ’ cells.

affinity and a shift of the haemoglobin oxygen dis- Table 28.3 Haematological abnormalities in

sociation curve to the right (see p. 21 ), which is renal failure.
augmented by uraemic acidosis. The patient ’ s symp-

toms are therefore relatively mild for the degree of Anaemia
anaemia. Reduced erythropoietin production
Other factors may complicate the anaemia of Aluminium excess in dialysis patients
chronic renal failure (Table 28.3 ): the anaemia of Anaemia of chronic disorders
chronic disorders, iron deficiency from blood loss Iron defi ciency

during dialysis or caused by bleeding because of blood loss (e.g. dialysis, venesection, defective
defective platelet function, and folate defi ciency platelet function)
in some chronic dialysis patients. Aluminium excess Folate defi ciency
in patients on chronic dialysis also inhibits erythro- chronic haemodialysis without replacement
poiesis. Patients with polycystic kidneys usually therapy
have retained erythropoietin production and may Abnormal platelet function
have less severe anaemia for the degree of renal Thrombocytopenia
failure.
Immune complex - mediated (e.g. systemic lupus
erythematosus, polyarteritis nodosa)
Treatment Some cases of acute nephritis and following
allograft
Erythropoietin therapy has been found to correct Haemolytic uraemic syndrome and thrombotic
the anaemia in patients on dialysis or in chronic thrombocytopenic purpura
renal failure, providing that iron and folate defi - Thrombosis
ciency, aluminium excess and infections have been Some cases of the nephrotic syndrome
corrected. The dosage of erythropoietin usually

required is 50 – 150 units/kg three times a week by Polycythaemia
subcutaneous infusion. Maintenance by 75 units/ In renal allograft recipients
kg/week subcutaneously is typical. New prepara- Rarely in renal cell carcinoma, cysts, arterial
tions of erythropoietin are now used fortnightly disease