Anaemia

Anaemia is a condition in which red blood cells circulating in the body decrease in number ultimately leading to the lack of blood in the body. This is one of the most common blood disorders stating around one-third of the total world population suffers from anaemia.

Causes of Anaemia

Loss of blood 

Loss of blood is often the major cause of anaemia in human beings. Low iron levels lead to this form of the condition. Blood loss can be due to childbirth, surgical operations, trauma or accidents. Other causes of blood loss include

  • Gastrointestinal problems such as ulcers , hemorrhoids,cancer and gastritis.
  • Using non- steroidal anti – inflammatory drugs that includes aspirin and ibuprofen.
  • Prolonged or heavy menstrual bleeding. 

Impaired RBC

  • Our bone marrow is soft and the spongy tissues at the centre of bones plays a vital role . The bone marrow produces stem cells that produces RBC, white blood cells , and platelets.
  •  Also , sometimes RBC  do not grow and mature well in the case of thalassemia which is a hereditary form of anaemia.
  • Certain diseases like leukaemia, a type of cancer produces excessive and abnormal white blood cells ,impairing the production of RBC. 
  • The usual life span of RBC is 120 days . But sometimes, the body removes it before their complete natural life cycle. 
  • An another condition called as Auto immune haemolytic anaemia that occurs when our immune system mistakes RBC for a foreign unwanted substance and attacks the actual RBC in place of that.

Other factors that lead to the destruction of RBC are:-

  • Infection.
  • Using some antibiotics.
  • Severe hypertension/high blood pressure.
  • Vascular grafts as well as prosthetic heart valves .
  • Autoimmune disorders such as haemolytic disease.
  • Snake venoms.

What is the relation between Anaemia and CKD ?

  • Anaemia is a  common problem in chronic kidney disease. Inability of kidneys to filter blood and the wastes build up in the body. It is less common in the early stages of CKD but it gets often severe as the disease progresses and moreover kidney function is lost. 
  • Anaemia is a sign of disease defined when haemoglobin levels reaches below 13g/dL in men where as 12g/dL in women. 
  • To the CKD patients with Anaemia ,there is decrease in erythropoietin (EPO)  synthesis as well as iron deficiency (ID) A.
  • The condition of CKD has a direct relation with Anaemia. Profoundly, the revelation of CKD Anaemia progresses with the succession of CKD till it reaches to its advanced stages ,stating from 40% in stage 3 to 70% in stage 5 .
  • The assessment of iron -deficiency is also prevalent in CKD patients. The patients with advanced CKD posses a higher prevalence of functional iron deficiency in the body. The functional iron deficiency (ID) is characterized by restricted iron availability mainly due to some inflammatory conditions. Inflammatory conditions in the body releases hepicidin and probably reduces the gastrointestinal iron absorption ultimately, lowering the levels of iron and haemoglobin in the body. 
  • According to the reports , there lies a negative association of low Hb with CKD progression and even causes mortality. Also,Anemia is associated with 51% increase in the risks of myocardial infarction , strokes. 
  • There is a strong relation associated with the development of left ventricular hypertrophy and Anaemia. 
  • It has been found that most of the CKD patients with Anaemia reports fatigue. The lower haemoglobin levels in the body often restricts the energy levels affecting their daily activities. Out of a study , about 33% patients receiving haemodialysis asses fatigue. 

What are the complications of Anemia in someone with CKD ?

  • People with CKD half an increased chance have an increased chances of developing heart problems due to less availability of oxygen as compared to normal conditions.
  • People with CKD and anaemia are also at a high risk high risk of complications due to strokes.

What are the symptoms in people with CKD and anaemia as well?

The symptoms of anaemia in CKD people arise gradually and become noticeable in advanced stages.

The common symptoms of anaemia in CKD patients include

  • Tiredness fatigue
  • Breath shortness
  • Pale skin
  • Weakness
  • Body aches
  • Chest pain
  • Dizziness
  • Faint
  • Irregular heartbeat
  • Headaches
  • Sleep problems
  • Trouble concentration

What are the causes of anaemia in CKD?

  • The people have their kidneys damaged and so they produce less erythropoietin signalling the bone marrow to make less red blood cells. with less erythropoietin, the body makes few red blood cells in ultimately less oxygen are delivered to the organs and tissues.
  • People with anaemia in CKD tend to leave for a shorter duration than normal causing red blood cells replace or die faster than their normal life cycle.
  • People with anaemia in CKD forms low levels of nutrients such as Iran, vitamin be 12, folic acid required for making healthy red blood cells.
  • Other causes of anaemia in relation to CKD includes
  • Blood loss likely future with dialysis for kidney failures
  • Certain infection
  • Inflammation
  • Malnutrition.

How anaemia is diagnosed with CKD by health care professionals?

 certain facts such as medical history physical examination and blood tests are used for diagnosing anaemia with CKD.

Medical history

The health professionals record your medical history and that includes

  • Symptoms
  • Current and past conditions
  • Prescription overtime
  • Family history

physical examination

  • Your physical exams include
  • Blood pressure
  • Heart rate
  • Examining body that checks about changes in skin colour, rashes or bruising.

Blood test

Blood tests are used to check the signs of anaemia and what are health problems. blood test tells you about the following considerations

  • Number of blood cells
  • Average size of RBC
  • Haemoglobin count
  • Reticulocytes

How do doctors manage anaemia in CKD?

Firstly, the healthcare professional street any kind of underlying condition causing anaemia such as Iran or vitamin deficiency. The symptoms of anaemia can be controlled at the early stages with certain medications and treatments. However, you need to contact to a haematologist aura nephrologist to treat people with CKD or related conditions.

Iron

  • You may be prescribed some iron supplements either in the form of a pill or intravenous infusion if your body lacks the adequate amount of iron in the body.
  • If you are on a dialysis, you will be given an IV iron supplements during the dialysis treatment. 
  • Optimum iron content in the body makes healthy red blood cells.

Vitamins

  • You also need to take Vitamins specially vitaminnB12 or folate that are needed to make healthy blood cells in the body. 
  • The healthcare professionals suggest to intake this in order to avoid any complications.

Medicines

  • You need to take certain prescribed medicine that will increase erythropoiesis – stimulating agent (ESA) to treat Anaemia . ESAs let bone marrow produces more red blood cells.
  • Being on a haemodialysis ,you will receive some subcutaneous ESA’s . Also, you need to take iron supplements to help ESA’s to work better. 

Blood transfusion

  • In severe case of anaemia  ,the health professionals may recommend bro have certain blood transfusion to quickly increase the number of red blood cells and temporarily relieve the symptoms of Anaemia.
  • Sometimes, blood transfusion may result into some other health problems such as 
  • It may also develop some antibodies that damages or destroy the blood donor cells and lowers the chances of future kidney transplantation.
  • A disorder called as Iron overload or hemochromatosis may also occur . In this, iron from transfused red blood cells build up in the body and damages other organs as well.

How does your nutrition affects anaemia in CKD?

  • To manage Anaemia with CKD , you need to make certain changes in your diet plan. Develop your diet plan which includes foods that you enjoy and also maintains your kidney health and well manages your Anaemia.
  • Adhere to the foods that contains enough iron , Vitamin B12 ,folic acid . Your health care professional may suggest you to limit certain foods that are rich in protein, sodium or phosphorus for CKD patients. So, before making a change in the diet plan ,you must talk to your doctor to avoid any misunderstanding.

What is a critical haemoglobin level?

A haemoglobin level, particularly less than 5.0 g/dL (50g/L), may cause heart failure and even death due to insufficient circulation of blood in the body. 

Also, a value greater than 20g/dL ( 200g/L) can often lead to the blockage of capillaries as a result of hemoconcentration.

Does ESRO cause Anaemia? 

Anaemia and end-stage renal disease ( ESRD) are often called kidney failure. People with kidney failure who are on dialysis may have Anaemia. Also, kidney transplant patients do have a higher risk of Anaemia.

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