Transcription
Welcome back to Medicos is Perfection, Alice. Let's continue our talk on normocytic anemia, and today's topic will be anemia in chronic kidney disease.
In the good old days, we used to call it kidney failure or chronic kidney failure. Now we call it chronic kidney disease because we do not like "failure." Symptoms of anemia are the exact same thing: tired, pale, headache, lazy, dizzy, short of breath on exertion, angina. The signs will include stuff like murmur due to a hyper-dynamic circulation and so forth.
Here is your hematopoiesis slide. We start with stem cells and we go to our RBCs. So in anemia, we have a problem producing enough RBCs. All of these steps need something called EPO, erythropoietin, from your friend, the kidney. That's fine. And as you are well aware, MCV determines if the anemia is microcytic, normocytic, or macrocytic. Anemia related to chronic kidney disease is normocytic; MCV 80 to 100 fL; two liters. Okay, but first, I would like to answer a question from the previous video. In the last video on aplastic anemia, there was a question. The answer to the question will be D: phenytoin.
Now back to anemia in chronic kidney disease. As you know, the normal normocytic anemia, where the MCV is 80 to 100, has three main causes: blood loss, underproduction/destruction. Of course, the blood loss has to be acute. Underproduction has many causes; any chronic disease or iron deficiency. We have talked about them previously, each in a separate video. Aplastic anemia was discussed in the last video. Chronic renal failure or chronic kidney disease—that's today's topic. So let's jump in.
So anemia in chronic kidney disease starts at stage 3 chronic kidney disease and is almost universal by stage 4. What are these stages of chronic kidney disease? They are stages depending on the GFR. In the chronic kidney disease case, I've discussed them in a separate video called "The Five Stages of Chronic Kidney Disease Based on GFR." I will link it in the description.
What are the causes of anemia in general in cases of chronic kidney disease? A lot of them: relatively EPO deficiency, bleeding problem, chronic inflammation. And the link between anemia of chronic inflammation and chronic kidney disease is discussed in my video on chronic inflammation of chronic disease, part of me. So anemia of chronic inflammation is the same thing as anemia of chronic disease. We have folate or B12 deficiency, hemoglobinopathies, and immunosuppressive drugs.
Okay, how to treat? There is a new thing right now called the recombinant human ESA. ESA stands for erythropoietin-stimulating agents. This is EPO made artificially. We give them to people who are deficient in EPO. Some athletes abuse EPO to get more RBCs to carry more oxygen to perform more exercise. Dialysis and renal transplant, of course, if chronic kidney disease has stages like four, five, especially five, which is the end-stage kidney disease. Renal transplants. B12 and folate? Why? Because one of the reasons or the causes are B12 and folate deficiency.
Blood transfusion is now falling out of favor. Why? Because we have the new human ESA. Why blood transfusion bad? A lot of side effects: iron overload, infections, alloantibodies. These alloantibodies sensitize the patient to the donor skin. Let's say that we are performing a renal transplant in this patient who has received a lot of blood transfusions. He has a lot of alloantibodies. Alloantibodies are antibodies to other people, but not self. Self will be auto-alloantibodies. So they will attack the donor kidney. So renal transplantation will be a problem here due to the alloantibodies.
And here is today's question: How to manage transfusion-related iron overload? When you transfuse blood, you can get iron overload easily. How to manage this iron overload? Hint: You can give some drugs. Let me know in the comments, please. And I'll see you in the next video. We will continue our discussion on other causes of normocytic anemia. Take care.