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A Study of Hematological Profile in Patients of Chronic Renal Failure Undergoing Hemodialysis at a Tertiary Health Care Institute


Affiliations
1 Department of Pathology, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik-422003, Maharashtra, India
2 Department of Pathology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik-422003, Maharashtra, India
 

The complete blood count, peripheral blood smear, bleeding time, clotting time and renal function tests of 114 patients of chronic renal failure who had required hemodialysis for a period of at least 3 months prior to the commencement of this study were studied. The purpose of this study was to investigate the derangements in the haematological profile of chronic renal patients undergoing hemodialysis and to correlate the same with the duration and severity of the renal failure. The principal finding in the study was a 100% prevalence of anemia among chronic renal failure patients, which was predominantly of the normocytic normochromic type. Red blood cell count was reduced in nearly all (93%) of study patients. There was also a strong negative correlation (r = -0.74) between haemoglobin and duration of hemodialysis. However, a significant proportion of cases showed abnormal cells in the peripheral blood cells such as burr cells, schistocytes and pencil cells, suggesting other contributing factors to the anemia. Female patients also showed a significantly greater prevalence of increased red cell distribution width (>15%) as compared to males (p = 0.001) and a lower prevalence of normocytic normochromic anemia as compared to males (p = 0.009). White blood cell counts, platelet counts, and bleeding and clotting times were largely within normal limits, and none of these variables showed a statistically significant association with the duration of hemodialysis, or serum creatinine, or serum blood urea nitrogen. The inference from the study is that anemia is a major comorbidity in end-stage renal failure patients, with many factors contributing to it, and detailed workup and effective treatment of anemia is necessary in this group of patients.

Keywords

Anemia, Bleeding Time, Clotting Time, Complete Blood Count, Hemodialysis, Normocytic Normochromic.
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  • Jha V, et al. Current status of end stage renal disease core in India. Kidney International Supplements. 2013; 3:157–60.https://doi.org/10.1038/kisup.2013.3

  • National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidneydisease: evaluation, classification, and stratification. Am J Kidney Dis, 2002; 39:1–266. PMid:11774095

  • Rajapurkar, et al. What do we know about chronic kidney disease in India: First report of the Indian CKD registry. BMC Nephrology. 2012; 13:10. https://doi.org/10.1186/14712369-13-10 PMid:22390203 PMCid:PMC3350459

  • McGonigle RJ, Shadduck RK, Fisher JW. Erythropoietin deficiency and inhibition of erythropoiesis in renal insufficiency. Kidney Int. 1984; 25:437–44. https://doi.org/10.1038/ ki.1984.36 PMid:6727139

  • Subhan-ud-din, Shah SAR. Haemostatic defects in chronic kidney disease. J Med Sci. 2013 Jul; 21(3):149–52.

  • World Health Organization. Iron deficiency anemia: Assessment, prevention and control. A guide for programmer manager; Geneva: WHO 2001. Available from:http://apps.who.int/iris/bitstream/10665/66914/1/WHO_ NHD_01.3.pdf?ua=1

  • Palmer L, et al. ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features. Int Jnl Lab Hem. 2015; 37:287–303.https://doi.org/10.1111/ijlh.12327 PMid:25728865

  • Arun S, Prabhu MV, Chowta KN, Bengre ML. The hematological pattern of the patients with chronic kidney disease in a tertiary care setup in South India. Journal of Clinical and Diagnostic Research. 2012 Aug; 6(6):1003–6.

  • Chinwuba I, Uchenna I, Ngozi I. High prevalence of anemia in predialysis patients in Enugu, Nigeria. Nephrology Reviews.2010; 2:14.

  • Islam MN, FerdousA, Zahid AZ, Alam M, Islam MN. Haematological profile of patients with chronic kidney disease in Northern Bangladesh. Dinajpur Med Col J. 2015 Jan; 8(1):21–7.

  • Bhattacharjee K, Das D, Rabha P, Kalwar AK, Kar G, Bhattacharjee P. A study on hematological profile in patients of chronic renal failure with special reference to serum iron profile. Journal of Evidence based Medicine and Healthcare.2015; 2(46):8212–9. https://doi.org/10.18410/jebmh/ 2015/1107

  • George SV, Pullockara JK, Sailesh KS, Mukkadan JK. A study to assess changes in the hematological profile inchronic kidney disease. The Pharma Innovation Journal.2015; 4(6):1–3.

  • Bhatta S, Aryal G, Kafle RK. Anemia in chronic kidney disease patients in predialysis and postdialysis stages. Journal of Pathology of Nepal. 2011; 1:26–9. https://doi.org/10.3126/ jpn.v1i1.4446

  • Barde R, Patel HV, Shah PR. A study of anemia prevalence in CKD patients on maintenance hemodialysis: A single centre study. Journal of Evidence Based Medicine and Healthcare. 2015; 2(39):6344–48. https://doi.org/10.18410/ jebmh/2015/871

  • Hakim YAH, et al. The effect of hemodialyis on hemoglobinconcentration Platelet count and white blood cell count

  • in end-stage renal failure. Int Journal of Medical Research and Health Sciences. 2016; 5(5):22–35.

  • Mudiyammanavara NR, Dhananjaya PE, Agarwal R. Cross sectional study of anaemia in chronic kidney disease. Indian Journal of Basic and Applied Medical Research. 2015 Mar; 4(2):414–9.

  • Reza A, Suzan S, Javad S, Mahnaz A. Hematological profile of Chronic Kidney Disease (CKD) patients in Iran, in pre-dialysis Stages and after Initiation of Hemodialysis. Saudi J Kidney Dis Transpl. 2009; 20(1):368–71.

  • Tennankore KK, Soroka SD, West KA, Kiberd BA. Macrocytosis may be associated with mortality in chronic hemodialysis patients: A prospective study. BMC Nephrology. 2011; 12:19. https://doi.org/10.1186/1471-2369-12-19 PMid:21569355 PMCid:PMC3114714

  • Talwar VK, Gupta HL, Shashinarayan. Clinico-haematological profile in chronic renal failure. The Journal of Association of Physicians of India. 2002; 50:228–33. PMid:12038654 20. Chandra M. Pathogenesis of the anemia of chronic renal failure: The role of erythropoietin. Nefrologia. 1990; 10.

  • Cole CH. Decreased ouabain-sensitive adenine triphosphatase activity in the erythrocyte membrane of patients with chronic renal disease. Clin Sci. 1973; 45:775. https://doi.org/10.1042/cs0450775

  • Vos FE, et al. Red blood cell survival in long-term dialysis patients. Am J Kidney Dis. 2011; 58(4):591–8. https://doi.org/10.1053/j.ajkd.2011.03.031 PMid:21715072

  • Orringer EP, Mattern WDL. Formaldehyde-induced hemolysis in chronic hemodialysis. N Engl J Med. 1976;294:416. https://doi.org/10.1056/NEJM197606242942602 PMid:178999

  • Rathod SG, Ade AK, Shekokar PP. A study of haematological changes in chronic renal failure. Sch J App Med Sci.2014; 2(4A):1232–4.

  • Gafter U, Bessler H, Malachi T, Zevin D, Djaldetti M, Levi J.Platelet count and thrombopoietic activity in patients with chronic renal failure. Nephron. 1987; 45(3):207–10. https:// doi.org/10.1159/000184118 PMid:3574570

  • Dorgalaleh A, et al. Anemia and thrombocytopenia in acute and chronic renal failure. Int J Hematol Oncol Stem Cell Res. 2013; 7(4):34–9. PMid:24505541 PMCid:PMC3915422

  • Kaw D, Malhotra D. Hematology: Issues in the dialysis patient: Platelet dysfunction and end-stage renal disease. Seminars in Dialysis. 2006; 19:317–22. https://doi.org/10.1111/ j.1525-139X.2006.00179.x PMid:16893410

  • Van Bladel ER, et al. Platelets of patients with chronic kidney disease demonstrate deficient platelet reactivity in vitro. BMC Nephrology. 2012; 13:127. https://doi.org/10.1186/1471-2369-13-127 PMid:23020133 PMCid:PMC3473261

  • Butt M, Shafi T, Farooq IK. Effects of dialysis on bleeding time in chronic renal failure. J Pak Med ASS. 1998; 48:242–4.

  • Ramaprabha P, Bhuvaneswari T, Kumar RA. Coagulation profiles an indicator of vascular haemostatic function in chronic renal failure patients who are on renal dialysis. Sch J App Med Sci. 2014; 2(2B):592–5.

  • Eberst E, Berkowitz LR. Hemostasis in renal disease: Pathophysiology and management. Am J Med. 1994; 96:168–79.

  • https://doi.org/10.1016/0002-9343(94)90138-4


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  • A Study of Hematological Profile in Patients of Chronic Renal Failure Undergoing Hemodialysis at a Tertiary Health Care Institute

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Authors

Arjun Chakravarti
Department of Pathology, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik-422003, Maharashtra, India
Archana Ukey
Department of Pathology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik-422003, Maharashtra, India
Preeti Bajaj
Department of Pathology, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik-422003, Maharashtra, India
Pradnya Saragade
Department of Pathology, Dr. Vasantrao Pawar Medical College Hospital & Research Centre, Nashik-422003, Maharashtra, India

Abstract


The complete blood count, peripheral blood smear, bleeding time, clotting time and renal function tests of 114 patients of chronic renal failure who had required hemodialysis for a period of at least 3 months prior to the commencement of this study were studied. The purpose of this study was to investigate the derangements in the haematological profile of chronic renal patients undergoing hemodialysis and to correlate the same with the duration and severity of the renal failure. The principal finding in the study was a 100% prevalence of anemia among chronic renal failure patients, which was predominantly of the normocytic normochromic type. Red blood cell count was reduced in nearly all (93%) of study patients. There was also a strong negative correlation (r = -0.74) between haemoglobin and duration of hemodialysis. However, a significant proportion of cases showed abnormal cells in the peripheral blood cells such as burr cells, schistocytes and pencil cells, suggesting other contributing factors to the anemia. Female patients also showed a significantly greater prevalence of increased red cell distribution width (>15%) as compared to males (p = 0.001) and a lower prevalence of normocytic normochromic anemia as compared to males (p = 0.009). White blood cell counts, platelet counts, and bleeding and clotting times were largely within normal limits, and none of these variables showed a statistically significant association with the duration of hemodialysis, or serum creatinine, or serum blood urea nitrogen. The inference from the study is that anemia is a major comorbidity in end-stage renal failure patients, with many factors contributing to it, and detailed workup and effective treatment of anemia is necessary in this group of patients.

Keywords


Anemia, Bleeding Time, Clotting Time, Complete Blood Count, Hemodialysis, Normocytic Normochromic.

References





DOI: https://doi.org/10.18311/mvpjms%2F2017%2Fv4%2Fi2%2F9592