Anemia of chronic renal failure2017-05-06 17:54
CRF patients with different degrees of anemia, and with the decline of renal function, anemia gradually increased. The pathogenesis of CRF complicated with anemia has the following aspects:
(1) reduction of red blood cell production: the reduction of erythropoietin (EPO) is mainly caused by the production of glomerular proximal and mesenchymal cells. CRF, in addition to the kidney to produce erythropoietin damaged parts, reduce the affinity of hemoglobin for oxygen, the hemoglobin for oxygen increased rate of renal ischemia is not serious, the main factors to reduce erythropoiesis, resulting in significantly reduced erythropoietin. Inhibition of bone marrow: CRF, the accumulation of certain toxic substances in the blood of the bone marrow has a direct inhibitory effect, causing hematopoietic dysfunction. The iron: iron storage and dynamic disorder of reticuloendothelial system abnormal metabolism, metabolism of hemoglobin out of the iron release is affected, the result is reduction of serum iron supply and bone marrow iron reduction effect of hematopoietic. Folic acid deficiency: CRF deficiency due to inadequate intake of folic acid deficiency. In addition, the increase in folic acid binding protein in patients with uremia, can reduce the number of folic acid transferred to the cell. Long term dialysis patients are more likely to develop folate deficiency.
(2) the destruction of red blood cells increase. The reasons include: the effect of high blood polyamines caused by shortening the life of red blood cells occurred autolysis; uremia red blood cell metabolism and erythrocyte fragility increased, erythrocyte induced by autolysis; microvascular disease causes red blood cells to mechanical damage and destruction; hypersplenism.
(3) increase in red blood cell loss: chronic upper digestive tract or lower digestive tract occult bleeding, laboratory blood tests or blood loss of residual blood dialysis, can aggravate anemia.