Haematologic Indices and the Response to Erythropoetin Therapy in Chronic Renal Failure

Abstract

Anaemia has for long been recognized as one of the commonest complications of chronic renal failure. It has been found to significantly influence morbidity; mortality and health-related quality of life in these patients. In a bid to further categorize the anaemia in Nigerians with CRF and provide preliminary data on their response to r-HUEPO treatment we conducted this prospective open labelled c1inico-pathologic study. Thirty consecutive newly diagnosed CRF patients aged 40. 17±13.4 years and 25 healthy, age and sex-matched controls were studied. The mean creatinine clearance (Cr Cl) was 11.68 ± 9.16 ml/min in the patients and 94.0±16.67m1s/min in controls. A comprehensive assessment of their renal status was done as well as full haematological profile including bone marrow aspiration and staining, prothrombin time and bleeding time. Stool test for occult blood and microscopy was done. Urine microscopy, culture and sensitivity were also carried out on all subjects. Subcutaneous recombinant erythropoietin was offered to those that were able to afford it at the dose of 50 units/kg body weight up to a maximum of -WOO units thrice weekly and the response monitored over the study period. We found that anaemia was present in all patients; PCV ranged between 10% and 35% (mean ± SD; 20.27 ±5.6%), in contrast with 37 -48% (mean ±SD; 41.96 ±16.67%) in normals. PCV correlated positively with creatinine clearance (r=0.97, P =0.0043) and negatively with bleeding time (r=0.49; P=0.043). The bleeding time was prolonged in 9 (36%) of the patients while it was normal in all controls (P<O.OOl). Ten Patients had malaria parasitaemia (40%) at presentation when compared with
only 3(12%) of the controls (P=0.05). 88% of the patients had normal leucocyte count while all the control subjects had normal leucocyte counts. The platelet counts in the study group ranged between 86 and 246 x 109fLwhile for controls it ranged between 90 and 330 x 109/L. Twenty (80%) patients had hypocellular marrow while the remaining 5 (20%) had normocellular marrow. Marrow iron was normal in 12(40%) patients reduced in 11(36.7%) and absent in 7 (23.3%). Recombinant human erythropoietin therapy was effective in 90% of patients that had it. The mean PCV rose from 20.6 ± 3.3 % to 33.6 ± 4.3 % (p=0.008) and retic index from 0.38 to 1.04 over the study period. We conclude that anaemia of increasing severity is common in CRF patients and worsens with progression of the disease; it is hypoproliferative with normochromic normocytic picture in the majority of the patients. Contributory factors include iron deficiency, inadequate dialysis dosing, increased bleeding tendencies and megaloblastic anaemia. Erythropoietin therapy was effective but was unaffordable for the majority of our patients.