Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Macrocytic anemia with megaloblasts
4%
3/76
Macrocytic anemia without megaloblasts
3%
2/76
Microcytic anemia
5%
4/76
Normocytic anemia with decreased reticulocyte count
83%
63/76
Normocytic anemia with increased reticulocyte count
Select Answer to see Preferred Response
This patient’s normochromic anemia in the setting of chronic kidney disease is likely due to anemia of chronic disease, which is a normocytic anemia with a decreased reticulocyte count. For patients with kidney disease, renal production of erythropoietin (EPO) is affected. This anemia from chronic kidney disease tends to be seen once the glomerular filtration rate (GFR) drops below 60 ml/min/1.73m^2 (stage 3 or higher). Since EPO stimulates the bone marrow to produce red blood cells, exogenous EPO needs to be administered in patients with chronic kidney disease and anemia. Due to slowed red blood cell production, the reticulocyte count is decreased, resulting in a normocytic, normochromic anemia. This is in contrast to hemolytic anemias, which are also normocytic but have increased reticulocyte counts. Incorrect Answers: Answer 1: A macrocytic anemia with megaloblasts occurs when there is impaired DNA synthesis. This can occur in many situations, such as folate or B12 deficiency or orotic aciduria when there is a defect in UMP synthase. This patient’s history does not suggest a risk for these. Answer 2: A macrocytic anemia without megaloblasts can occur in situations that do not involve impaired DNA synthesis. This includes alcoholism and liver disease. This patient’s history does not suggest a risk for these. Answer 3: A microcytic anemia occurs with a mean corpuscular volume of < 80 fL. These are hypochromic and are most commonly due to iron deficiency from chronic bleeding. This patient does not have any evidence of chronic bleeding and does not appear to have any risk factors for hereditary microcytic anemias such as thalassemia or sideroblastic anemia. Answer 5: A normocytic anemia with increased reticulocyte count occurs in the sideroblastic anemia, which is due to a defect in heme synthesis. While this can be X-linked, it can also be acquired from myelodysplastic syndromes or B6 or copper deficiency. Bullet Summary: Anemia associated with chronic kidney disease is due to reduced erythropoietin production and can be treated with exogenous erythropoietin.
3.3
(3)
Please Login to add comment