Weakness and easy fatigability: Anemic patients always feel tired and exhausted with any minor effort.
Manifestations of anemia:
1) Weakness and easy fatigability: Anemic patients always feel tired
and exhausted with any minor effort. This symptom could be corrected easily
once the anemia is corrected.
2) Loss of concentration: Mental fatigue is also common among anemic
patients. In school age education delay is common among anemic students.
3) Sexual dysfunction: In addition to the hazardous impact of uremic
toxins, anemia may alter your power of sexual performance. Many factors
actually share in this complication like elevated prolactin hormonal levels.
4) Difficulty in breathing: Without the presence of a particular chest
disease, anemic patient may feel a difficulty in breath. This is partly can be
attributed to respiratory muscle fatigue and defective oxygenation.
5) Cardiac complications: The anemic heart cannot function properly
like non-anemic one. Oxygenation of the cardiac muscle is insufficient due to
diminished hemoglobin levels. Moreover, failure of the heart power (heart
failure) a serious complication of anemia and can also be complicated by
cardiac asthma due to coronary insufficiency with chest pain with minimal
effort.
6) Stunted growth in children: Anemia is one of the most common causes
of stunted growth in children particularly in developing countries. Early
diagnosis of anemia in the child can help recovery of his growing status up to
normal levels.
7) Depression: Psychological impact of anemia cannot be overlooked.
Whether this complication is a reflection of the patients’ anemic defects or it
is pure psychiatric complication is uncertain.
8) Bleeding orifices e.g., bleeding nose or bleeding per rectum that
may be related to other blood diseases and share in anemia development.
Now, what are the treatment options for a patient
with anemia related to kidney disease?
After
completion of laboratory tests to settle the diagnosis of anemia, other tests
concerned with elucidation of various causes of anemia should be accomplished
e.g. serum ferritin that denotes the amount of iron stores, serum iron,
transferrin saturation (TSAT) and vitamin levels. Treatment of anemia can go in
various direction:
1)
Repletion
of nutritional deficiencies, e.g.,
1.
Iron
supplements, either oral or intravenous.
2.
Cyanocobalamin
(B12) supplements, usually by parenteral regular injections.
3.
Folic
acid supply usually 5 mg BD.
2)
ESA
(erythropoiesis stimulating agents): i.e., erythropoietin therapy (EPO): many
forms are available e.g., EPO a, B, and the weekly form,
darbepoetin injection.
3)
Blood
transfusion: in critical cases, when anemia is sever and endangering the
patient’s life, we cannot wait until the above options start to correct anemia,
rather one or two units can be administered immediately to the patients. Safe
blood transfusion include cross matching for the transfused blood. Usually the
same blood group is preferred or the most accepted according to the cross
matching. However, mismatch in blood transfusion may result in a serious
reaction in the form of rigors, fever, rash, RBCs destruction and appearance of
yellow discoloration of the conjunctiva of the eye (jaundice). So. We reserve
blood transfusion only for critical cases with very low hemoglobin levels
(e.g., 6-7 g/l).
What are the hazards of EPO therapy?
Erythropoietin
(EPO) is a costly tool to correct anemia. It is also time-consuming. However,
some drawbacks could be expected with the start of this kind of therapy:
1)
Elevation
of blood pressure (Hypertension): with stimulation of the red blood cells
production, an elevation of the blood pressure will be expected. If the patient
is hypertensive before, his antihypertensive medications should be revised by
his physician.
2)
Elevation
of serum potassium (hyperkalemia).
3)
Increased
blood acidity.
4)
Increased
possibility of thrombo-coagulative disorders (blood clotting).
How can the process of dialysis be performed?
Dialysis is the
process by which the blood of a patient with renal failure can be purified by
toxins removal as well as removal of extra water inside his body. Once the
diagnosis of end-stage kidney disease has been made, patient will be prepared
for dialysis. However, this preparation is advised to be as early as possible
before the general condition is deteriorated and the nutritional status became
very poor with loss of weight and cachexia.
Preparation for dialysis
A kidney failure patient should have an access for dialysis that called “vascular access”. There are many types of accesses according to how much time it can be available for dialysis, for example, (1) temporary access, it can be used transiently until a permanent or semi-permanent access became available, e.g., femoral catheter that can be inserted under local anesthesia in the femoral vein in your groin. (2) Semi-permanent access, e.g., an internal jugular catheter that is a hard catheter that can be inserted in jugular vein in the one side of your neck. (3) Permanent access, vascular surgeon may connect a peripheral artery to a peripheral vein, so that the vein will be arterialized i.e. can be pulsating, it is called arteriovenous fistula (A/V fistula). By time the vein caliber will be larger in diameter and be ready to supply an enough amount of blood for dialysis. Another permanent access that is synthetic in nature, the A/V graft, it is a synthetic tube connecting the artery side to . It provides the purpose like fistula but its size will not enlarge the side venous
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