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Hypoproliferative anemia: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Hypoproliferative anemia is the result of a deficiency of erythropoietin (EPO) or a decrease in its response; they are, as a rule, normochromic and normocytic. Kidney diseases, metabolic and endocrine diseases are most often the cause of this type of anemia. Treatment is aimed at correcting the underlying disease and sometimes using erythropoietin.
Hypoproliferation is the most frequent mechanism of anemia in kidney disease, hypometabolic state or endocrine insufficiency (eg, hypothyroidism, hypopituitarism) and hypoproteinemia. The mechanism of anemia is associated either with insufficient efficacy or with insufficient production of erythropoietin. In hypometabolic conditions, there is also an insufficient bone marrow response to erythropoietin.
[Anemia in kidney disease
Inadequate production of erythropoietin by the kidneys and the severity of anemia correlate with the progression of renal dysfunction. Anemia occurs when the creatinine clearance is less than 45 ml / min. Disorders from the glomerular apparatus (for example, amyloidosis, diabetic nephropathy) usually show the most pronounced anemia for their degree of excretory insufficiency.
The term "anemia due to kidney disease" only reflects the fact that the cause of anemia is the reduction of erythropoietin, but other mechanisms can increase its intensity. With uremia, moderately expressed hemolysis may develop, the mechanism of which is unclear to the end. Occasionally, fragmentation of erythrocytes (traumatic hemolytic anemia) occurs when the reninovascular endothelium is damaged (for example, in malignant hypertension, nodular polyarthritis, or acute cortical necrosis). Traumatic hemolysis in children can be acute, often lethal and is defined as hemolytic-uremic syndrome.
The diagnosis is based on the presence of renal failure, normocytic anemia, reticulocytopenia in the peripheral blood, insufficient erythroid hyperplasia for a given degree of anemia. Fragmentation of erythrocytes in the smear of peripheral blood, especially when it is combined with thrombocytopenia, presupposes the presence of simultaneously traumatic hemolysis.
Therapy is aimed at improving renal function and increasing the production of red blood cells. With normalization of kidney function, anemia is gradually normalized. In patients on long-term dialysis, erythropoiesis may be improved, but complete normalization is rarely achieved. Therapy of choice is the administration of erythropoietin from a dose of 50 to 100 U / kg intravenously or subcutaneously 3 times a week simultaneously with the appointment of iron. In almost all cases, the maximum increase in the levels of red blood cells is achieved at 8-12 weeks. Reduced doses of erythropoietin (approximately 1/2 of the initial dose) can then be prescribed 1 to 3 times per week. In transfusions, as a rule, there is no need.
Other hypoproliferative anemia
Clinical and laboratory features in other hypoproliferative normochromic, normocytic anemias are similar to anemia in kidney disease. The mechanism of anemia in conditions of protein deficiency can be caused by general hypometabolism, which can reduce the bone marrow response to erythropoietin. The role of protein in hemopoiesis is still unclear.