Question for Kidneydoc about Haemoglobin

[billybags]

Hi Kidneydoc, can you explain in plain language why Haemoglobin drops. My husband has been on Haemo for nearly 3 months and in that time his HB is up and down alot, more down than up. He is having EPO injections at each session. Another question is he suffers from RLS and this has been considerable worse. Does it have anything to do with his HB? Looking forward to your answer.

[paul.karen]

I cant say why hemoglobin drops but from what i understand you need iron to replenish your red blood cells.  Once you start getting Epo shots or like shots you have to keep tabs on your iron.  The epo wont work unless there is iron in your system to replenish the blood cells.  So be sure to keep a check on iron levels.  I just had three one hour infusions of iron to balance out my  arsnep shots and get my hemoglobin in check.

[Zach]

In addition to what paul.karen said, you also need folic acid and B12 vitamin.  Wait till after treatment to take them or they get dialyzed out.

[jbeany]

Healthy kidneys make epo as part of their normal function.  The epo tells your bone marrow to make red blood cells.  Failing kidneys may lose their ability to make epo, so the bone marrow doesn't get the message to make more red blood cells.  The iron and other vitamins are building blocks for the blood cells.  High doses of epo alone won't help - the message to the bone marrow gets thru, but you can't build without the right parts.

[kidneydoc]

It is important to determine the cause of an abnormal Hb in patients with kidney disease.

In patients on dialysis there may be a low Hb due to.
1. The blood cells sticking to the line with each treatment despite adequate wash back.
2. The Elevation of toxins in the blood which result in micro bleeds in the Gut leading to iron loss.
3. Elevated levels of a hormone known as PTH which may alter the bone marrows ability to respond EPO.
4. The underlying disease process which led to kidney failure may itself have an effect on the blood count in some cases giving rise to anemia. This one is particularly common in patients with SLE or lupus where they may need separate treatment for there anemia other than EPO and also in patients with Sickle Cell Disease.
5. If his Hb is moving up to goal with administration of typical doses of EPO. But suddenly falling away then he is clearly responding to EPO which means the Bone marrow is OK and the iron stores may be adequate as well as the stores of all the vitamins necessary to see a response to EPO including folic acid b12 and so on so forth.

If the blood count falls away rapidly I would look for increased destruction of circulating red cells by any cause.
And
Increased losses of red cells (including repeated episodes of clotting on dialysis) such as a slow GI bleed that is not yet noticed.

[billybags]

Kidneydoc, I read with interest what you said, the one that interested me was "Elevated levels of a hormone known as PTH which may alter the bone marrows ability to respond EPO." Since he had to come off CAPDtube , out ,because of e-coli. he has had to go onto emergency haemo, his PTh has really shot up. They don't seem undully worried about this but it has esculated a lot. He is going back onto CAPD next week, had a new tube fitted. Will this affect the PTH or will it stay the same?

[kidneydoc]

For PTH to cause this problem with the bone marrow the elevation usually has to be long standing.

The cause for his elevation of PTH will need to be determined before being able to predict the change in PTH from therapy.

However He doesnt sound as if he is a non responder to EPO which is what bone marrow fibrosis from high PTH would cause.

He sounds more as if he is having losses of iron and red cells somewhere. If he was fine on CAPD then this may be because you lose a lot less blood with CAPD than hemo.

[billybags]

Kidneydoc. Thank you very much for the information you have sent me, it has answered my husbands questions and gave him a better understanding of the causes, and hopefully the levels will alter when he goes back on CAPD. Once again thank you very much.

[RightSide]

Hi Kidneydoc, can you explain in plain language why Haemoglobin drops. My husband has been on Haemo for nearly 3 months and in that time his HB is up and down alot, more down than up. He is having EPO injections at each session.

The reason is quite straightforward:

When the hemodialysis session is over, the techs try to get the blood from the machine back into the patient. But they can never do a perfect job; little amounts of blood are lost permanently at each session.  (Notice that when they throw away the dialyzer and tubing at the end of the session, it's still stained red.  That's blood.)  I guess it's like continuous lifetime menstruation.   

So over time, the blood count will drop.

This, of course, adds to the usual anemia from kidney failure, due to the kidneys not making enough erythropoetin to make new red blood cells.

[billybags]

RightSide, Thanks for that, it makes sense.

[KICKSTART]

Or ...it could be that Dracula is visiting  at night time ? Better hang out the garlic ..! 

[billybags]

KS, I'm sending him out on Saturday night (Halloween)