(Sometimes Hypochromic or Hyperchromic)
Normochromic anemia should also suggest the possibility of renal insufficiency, which will always lead to anemia within a few weeks. In cases of chronic renal insufficiency it is always present and may reach Hb values as low as 6 g/dl. The anemia is caused by changes in the synthesis of erythropoietin, the hormone regulating erythropoiesis; measurement of serum erythropoietin is an important diagnostic tool. Erythrocyte life span is also slightly reduced.
Apart from poikilocytosis, the blood cells are morphologically unremarkable. The reticulocyte counts often remain normal. The bone marrow does not show any significant characteristic changes, and therefore serves no diagnostic purpose in this situation.
Anemias due to renal insufficiency are usually normochromic, but hy-pochromic or hyperchromic forms do occur. Hypochromic anemia is an indicator of the reactive process that has led to the renal insufficiency (e.g., pyelonephritis and glomerulonephritis), resulting in secondary hypochromic anemia. In addition, dialysis patients often develop iron deficiency. Chronic renal insufficiency can lead to folic acid deficiency, and dialysis therapy will reinforce this, explaining why hyperchromic anemias also occur in kidney disease.
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