Anaemia Management by Joyce Lim

The speaker for the evening, Joyce Lim was introduced by PP Ng Yew Mun, who first met at her at RCJB’s Patients Day on 20 October 2011. Ms Joyce is from Jensen, which supplies RCJB’s dialysis centre with Heprin. Every year, Jensen sponsors the dialysis centre with RM1000.00 towards Patients Day.

At the talk, Ms Joyce informed members present of the importance of anaemia management in dialysis patients. Ms Joyce informed members of the function of the kidneys.

They are bean shaped, about the size of a fist, located at the middle of the back, just below the rib cage, on each side of the spine. The kidneys are sophisticated reprocessing machines.

Each day, a person’s kidneys process about 200 litres of blood, to shift out about 2 litres of water and waste products and extra water.

The kidneys remove wastes and water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters. The kidneys also regulate the body’s level of substances such as sodium, phosphorus and potassium. They release Rennin which regulates blood pressure.

and Calcitriol, which is the active form of Vitamin D. The kidneys also help to maintain Calcium for the bones and for normal chemical balance in the body.

The kidneys release Erythropoietin or EPO, which stimulates the bone marrow to make red blood cells.

What causes Renal Anaemia? A damaged kidney will impair the production of Erythropoietin, which will reduce the number of red blood cells (RBC) and thereby result in anaemia. Erythropoietin is a protein hormone which is produced in the kidneys to stimulate the production of red blood cells. 95% of Erythropoietin is produced in the kidneys with another 5% in the liver.The main causes of anaemia are Erythropoietin deficiency, shorter life cycle and of RBC, iron deficiency, infections and inflammations, blood loss or hemolysis, secondary hyperparatyroidismin, B12 and Folate deficiency and Aluminium Toxicity.

The causes of iron deficiency may be blood loss during dialysis, GI bleeding and poor absorption of iron supplements or nutrients by the body.

Anaemia can be treated by blood transfusion; but if the donor was not examined and his blood is infectious, it carries the risks of transmission of contagious diseases such as Aids or Hepatitis. Blood transfusion can also lead to Immuno Sensitization; where the body’s immune system becomes sensitive and produces antibodies, which in turn can reduce the success rate of a future transplant. It can also cause Acute Hemolysis, which is a transfusion reaction, caused when incompatible blood cells are transfused to a patient.

Anaemia can also be treated by Erythropoietin injections and iron injections ( if the patient has iron deficiency ). Eprex injections can be given to a patient during pre-dialysis, haemodialysis and CAPD and where there is failing transplant. Erythropoeitin was first used by Dr Escbach on a human body in 1985.

From the chart, you will notice that Erythropoeitin is as effective as urinary EPO. Infact Eprex therapy removes the need for blood transfusions, relieves anaemic sympthoms, improves job security and well being, increases exercise tolerance and prevents CVD. Eprex treatments have to be tailored to the individual’s requirement, as it depends on the base line HB level, patient’s response and body weight.

The speaker was magnanimously thanked by Rtn Dr Vishwadeep for her very informative and enlightening talk on Anaemia Management For Dialysis Patients.