Hypoproliferative Anemia

This normocytic, normochromic anemia develops as a result of deficient erythropoietin (EPO) production or because the bone marrow does not respond to EPO appropriately. The most common causes for this are kidney diseases where the kidney function is reduced. When the kidney function is reduced to a creatinine clearance below 45 ml per minute, anemia occurs because EPO production decreases. Two disease processes that lead to severe anemia are amyloidosis and diabetic nephropathy. General starvation with protein deficiency will also lead to hypoproliferative anemia by a mechanism that is not fully understood.

Symptoms

Diagnostic tests

There are the laboratory findings of kidney failure with a high BUN, creatinine and a reduced creatinine clearance. In addition there is a low reticulocyte count, fragmentation of RBC’s in the peripheral blood smear and a lack of RBC precursor cells in the bone marrow.

Treatment

Treatment consists of normalizing the kidney function as much as this is possible, if necessary with dialysis. EPO treatment is also given starting with a lower dose of 50 to 100 units per kilogram intravenously or subcutaneously three times per week. In addition iron supplements are given (induction dose). After 8 to 12 weeks the maximum response in terms of increasing the RBC level is reached. Maintenance doses are about half of the induction doses. Transfusions are rarely needed.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you

References:

1. Merck Manual (Home edition): Anemia

2. Noble: Textbook of Primary Care Medicine, 3rd ed., Mosby Inc. 2001

3. Goldman: Cecil Medicine, 23rd ed., Saunders 2007: Chapter 162 – APPROACH TO THE ANEMIAS

Last Modified: Dec. 29, 2008