Anemia in renal disease

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  • By
  • Fatin Al-Sayes
  • MD, MSc, FRCPath
  • Consultant Hematology
  • Assistant Professor

Anemia in renal disease

  • Seen in chronic renal failure
  • Severity relates to the degree of renal impairment
  • Due to inadequate EPO secretion
  • Other contributory factors
    • Bone marrow suppression secondary to uraemia
    •  RBCs survival
    • Uraemia cause platelets dysfunction leading to anaemia secondary to blood loss
    • Iron, folate loss during dialysis  anemia
    • Aluminum toxicity

Platelet and coagulation abnormalities:

  • Platelets dysfunction occur in CRF secondary to uraemia
  • HUS & TTP are associated with thrombocytopenia
  • Nephrotic syndrome is associated with thrombosis.

Laboratory changes:

  • Mostly normocytic-normochromic anemia.
  • Specific abnormalities in WBC, platelets

Anemia in liver disease

  • Common
  • Causes
  • Chronic disorder
  • Alcohol  with all direct effect on erythropoeisis
  • Folate deficiency
    • Alcohol  on folate metabolism
    • Nutritional deficiency
  • Blood loss from oesophageal varices
  • Hypersplenism

cont. of Causes

  • Hemolytic anemia
    • Zieve’s syndrome
    • Autoimmune in association with chronic active hepatitis
    • Viral hepatitis may provoke oxidative hemolysis
    • Acute liver failure
    • Coagulation abnormalities
  • DIC and microangiopathic hemolytic anemia

Endocrine disease

  • Hypopituitarism
    • Normocytic-normochromic anemia
    • Leucopenia
  • Thyroid disorders
    • Hypothyroidism can cause normocytic-normochromic anemia, microcytic or macrocytic type of anemia
  • Adrenal disorders
    • Hypoadrenalism result in normochromic, normocytic anemia
    • Cushing’s disease result in erythrocytosis

Connective tissue disorders Hematological changes:

  • Anemia of chronic disorders
  • GIT blood loss leading to iron deficiency anemia
  • Bone marrow suppression
  • Autoimmune hemolytic anemia occurs in SLE

Platelets and Coagulation Abnormalities

  • Autoimmune thrombocytopenia
  • Antiphospholipid antibodies are described in SLE

Metastatic malignant diseases

  • Anemia
    • Anemia of chronic disorders
    • Blood loss and iron deficiency
    • Marrow infiltration
    • Folate deficiency
    • Marrow suppression from radiotherapy or chemotherapy
    • hemolysis

cont. of Metastatic malignant diseases

  • White cell changes
    • Leukaemoid reaction
    • Malignant cells may circulate in the blood
    • WBC’s changes associated with eg. Hodgkin’s disease
  • Coagulation and platelets abnormalities
    • Thrombocytosis
    • DIC
    • Acquired inhibitors to coagulation factors


  • Bacterial infection
  • Chronic bacterial infection
    • E.g. TB  anemia, secondary to marrow replacement and fibrosis

cont. of Infection

  • Viral infection
    • Infectious mononucleosis is associated with cold type autoimmune hemolytic anemia
    • Aplastic anemia secondary to hepatitis A, C, etc.
    • Acute thrombocytopenia occur in viral infection, e.g. EB, MCV
    • Parvovirus-B19 is usually accompanied by pure red cell aplasia

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