Bone Marrow Amyloidosis in Hemodialysis Patients
Bone Marrow Amyloidosis in Hemodialysis Patients
The resistance to erythropoietin, which is used to treat normochromic, normocytic anemia in chronic renal failure, can develop in patients with conditions such as iron deficiency, aluminum toxicity, hyperparathyroidism, chronic inflammatory diseases, and primary hematological disorders. We found amyloidosis in the bone marrow of a woman without any other etiology for erythropoietin resistance who was undergoing chronic hemodialysis. Her anemia did not improve, despite 6 months of erythropoietin therapy. Bone marrow amyloidosis was found to be the reason for erythropoietin-resistant anemia in our patient with chronic renal failure and renal anemia. We present the case of bone marrow amyloidosis because it is a very rare cause of erythropoietin resistance.
Normocytic, normochromic anemia is present in the majority of patients with chronic renal failure (CRF). The primary cause of anemia in patients with CRF is insufficient production of erythropoietin (EPO) by the diseased kidneys. In CRF, the development of anemia is due to not only EPO deficiency but also to factors such as iron deficiency, acute and chronic blood loss, severe hyperparathyroidism, acute and chronic inflammatory conditions, aluminum toxicity, folate and vitamin B12 deficiency, malnutrition, inadequate hemodialysis, shortened erythrocyte survival time, hypothyroidism, underlying hemoglobinopathies, multiple myeloma, and hemolysis. Principal treatment of renal anemia consists of effective dialysis, restoration of missing components (especially iron), and control of renal osteodystrophy, as well as the appropriate dosage and duration of treatment with EPO. Recombinant human EPO has been used in the treatment of the anemia of CRF since 1986. EPO resistance in patients can be due to infections, chronic blood loss, osteitis fibrosa, aluminum toxicity, primary hematological diseases, folic acid or vitamin B12 deficiency, multiple myeloma, malnutrition, or iron deficiency. EPO resistance due to angiotensin-converting enzyme inhibitors has been suggested. If anemia is not corrected in a patient, despite appropriate dosage and duration of therapy, then the reasons for this should be explored. We present a case of amyloidosis of the bone marrow in a patient without any other etiology for erythropoietin resistance whose anemia has not improved, despite 6 months of EPO therapy.
The resistance to erythropoietin, which is used to treat normochromic, normocytic anemia in chronic renal failure, can develop in patients with conditions such as iron deficiency, aluminum toxicity, hyperparathyroidism, chronic inflammatory diseases, and primary hematological disorders. We found amyloidosis in the bone marrow of a woman without any other etiology for erythropoietin resistance who was undergoing chronic hemodialysis. Her anemia did not improve, despite 6 months of erythropoietin therapy. Bone marrow amyloidosis was found to be the reason for erythropoietin-resistant anemia in our patient with chronic renal failure and renal anemia. We present the case of bone marrow amyloidosis because it is a very rare cause of erythropoietin resistance.
Normocytic, normochromic anemia is present in the majority of patients with chronic renal failure (CRF). The primary cause of anemia in patients with CRF is insufficient production of erythropoietin (EPO) by the diseased kidneys. In CRF, the development of anemia is due to not only EPO deficiency but also to factors such as iron deficiency, acute and chronic blood loss, severe hyperparathyroidism, acute and chronic inflammatory conditions, aluminum toxicity, folate and vitamin B12 deficiency, malnutrition, inadequate hemodialysis, shortened erythrocyte survival time, hypothyroidism, underlying hemoglobinopathies, multiple myeloma, and hemolysis. Principal treatment of renal anemia consists of effective dialysis, restoration of missing components (especially iron), and control of renal osteodystrophy, as well as the appropriate dosage and duration of treatment with EPO. Recombinant human EPO has been used in the treatment of the anemia of CRF since 1986. EPO resistance in patients can be due to infections, chronic blood loss, osteitis fibrosa, aluminum toxicity, primary hematological diseases, folic acid or vitamin B12 deficiency, multiple myeloma, malnutrition, or iron deficiency. EPO resistance due to angiotensin-converting enzyme inhibitors has been suggested. If anemia is not corrected in a patient, despite appropriate dosage and duration of therapy, then the reasons for this should be explored. We present a case of amyloidosis of the bone marrow in a patient without any other etiology for erythropoietin resistance whose anemia has not improved, despite 6 months of EPO therapy.
Source...