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Ovid: Oxford Handbook of Dialysis

Editors: Levy, Jeremy; Morgan, Julie; Brown, Edwina Title: Oxford Handbook of Dialysis, 2nd Edition Copyright ©2004 Oxford University Press > Table of Contents > Part 8 – Complications of ESRD: anaemia > Assessment of anaemia and haemolysis Assessment of anaemia and haemolysis Investigating anaemia in ESRD Should be performed when Hb < 13 g/dl (men) or 12 g/dl (women). Initially:

  • red blood cell indices;
  • blood film;
  • white blood cells and platelets;
  • reticulocyte count;
  • serum iron and total iron binding capacity;
  • transferrin saturation;
  • serum ferritin (and CRP);
  • stool occult blood.

These tests will exclude causes for anaemia other than renal failure itself, especially haemolysis, haematinic deficiency, bone marrow suppression, or infiltration. Haemolysis Can be caused by:

  • contaminants in the dialysate (chloramines—an oxidant—copper, nitrates);
  • hypo-osmolar or overheated dialysate;
  • re-use sterilants (formaldehyde inducing antibodies);
  • blood pump trauma to red blood cells;
  • high flows through narrow intravenous catheters or needles;
  • drug induced (penicillin, cephalosporin, quinidine, methyldopa);
  • causes of microangiopathic haemolytic anaemia or autoimmune haemolysis.

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