Anemia

The normochromic normocytic anemia of chronic renal failure results from erythropoietin deficiency and increased red cell destruction; fragmented (burr) cells and a slightly increased reticulocyte count are typical. Iron absorption is normal, but dietary intake may be decreased due to reduced meat consumption and anorexia. Folate supplementation is required by patients undergoing regular hemodialysis. Correction of the anemia is possible by the regular parenteral administration of recombinant erythropoietin, although the onset of action is slow and the hormone is ineffective in the context of chronic inflammation or infection (raised C-reactive protein) so that anemia will rapidly reappear in treated patients who develop acute inflammation or infection.

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