Idiopathic Erythrocytosis in Dialysis Patients: A Case Report and Literature Review

A 78-year-old man on hemodialysis presented to our hospital with erythrocytosis. He had started hemodialysis 4 years previously, with a hemoglobin level of 9.8 g/dL, and was administered erythropoiesis stimulating agents and ferrous sulfate. Two years previously, his hemoglobin level increased to 14.5 g/dL and the treatment for anemia was discontinued. He continued hemodialysis thrice weekly; however, the hemoglobin level had increased to 17.0 g/dL at the time of presenting to our hospital. His serum erythropoietin level was 31.4 mIU/mL (range, 3.7–31.5 mIU/mL), carboxyhemoglobin level was 0.6% (range, 0–1.5%), and oxygen saturation in ambient air was 95.4%. The JAK2 V617F mutation was not observed and other bone marrow abnormalities were not identified. The patient was diagnosed with bladder cancer and a transurethral resection was performed. Eight months after the treatment of bladder cancer, his hemoglobin level was 15.1 g/dL, and he was diagnosed with idiopathic erythrocytosis.

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“…Sheqwara et al [8] reported occurrence of idiopathic erythrocytosis in a hemodialysis patient. The differences from our patient were as follows.…”

Section: Discussionmentioning

confidence: 99%

“…Acquired renal cystic disease is a frequently reported cause of secondary erythrocytosis in hemodialysis patients. The main mechanism of elevation in the serum erythropoietin levels in patients with acquired renal cystic disease involves the overproduction of erythropoietin by the epithelial lining of renal cysts [8] .…”

Section: Discussionmentioning

confidence: 99%

Idiopathic erythrocytosis in a patient on chronic hemodialysis

Lee

Min

Bae

et al. 2015

Kidney Research and Clinical Practice

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“…2 Pada umumnya pasien diberikan terapi ESA bila kadar hemoglobin di bawah 10g/dl karena keadaan anemia kronik sangat berbahaya bagi pasien PGK. 3 Pada beberapa kondisi ditemukan kadar hemoglobin yang normal pada pasien PGK yang menjalani terapi dialisis dengan status kadar hormon eritropoietin yang normal walaupun tanpa pemberian terapi ESA sebelumnya. Kondisi tersebut dapat ditemukan antara lain pada pasien PGK dengan koinfeksi hepatitis C. 3,4 Kami melaporkan sebuah kasus seorang laki-laki berusia 61 tahun dengan PGK dan ko-infeksi hepatitis C yang menjalani terapi hemodialisis di RSUP Prof. Dr. Dr. R. D. Kandou Manado.…”

Section: Pendahuluanunclassified

“…Eritropoietin umumnya dibentuk dari ginjal, tetapi hati juga dapat memroduksi eritropoietin dalam jumlah kecil. 3 Pasien yang rutin menjalani hemodialisis sering dikaitkan dengan infeksi hepatitis C mengingat proses penularan infeksi hepatitis C ialah dengan penetrasi langsung virus tersebut ke dalam membran sel dan menyebar ke sel darah. Pada pasien PGK yang harus menjalani hemodialisis secara rutin akan berisiko terinfeksi heaptitis C lebih tinggi.…”

Section: Bahasanunclassified

Gagal Ginjal Kronik Hemodialisis dengan Kadar Eritropoietin dan Hemoglobin Normal: Laporan Kasus

Amudi¹,

Palar²

2021

MSJ

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Generally, chronic kidney disease (CKD) is associated with anemia due to decrease of erythropoietin that plays an important role in erythropoiesis. We reported a patient, 61-year-old male, suffered from chronic hemodialysis kidney disease with coinfection of viral hepatitis C, albeit, had normal hemoglobin and erythropoietin levels. The patient was diagnosed as CKD in March 2014 with laboratory results, as follows: hemoglobin (Hb) 9.9 g/dl; ureum 223 mg/dl; creatinine 7.5 mg/dl, and was confirmed with ultrasonography. The patient underwent hemodialysis and was treated with erythropoiesis stimulating agent (ESA) for the first time in April 2014. The last ESA was given in June 2015 and the laboratory results were serum iron 61 µg/dl, total iron binding capacity (TIBC) 173 µg/dl, ferritin 1431 ng/ml, and the qualitative anti HCV test was reactive. Afterwards, the patient was not treated with ESA anymore since his Hb level was normal without ESA or blood transfusion. Moreover, the erythropoietin (EPO) level was tested in December 2018 resulted within normal level. Until now, the patient is still undergoing hemodialysis without ESA or transfusion. This is a rare condition, and there is still no certain pathophysiology to explain. It is assumed that the mechanism is related to hepatitis C infection that stimulates the hepatocyte regeneration, therefore, the cells produce endogen erythropoietin resulting in increased Hb level.Keywords: chronic kidney disease (CKD), erythropoietin and hemoglobin level Abstrak: Umumnya penyakit ginjal kronik (PGK) disertai dengan anemia akibat penurunan eritropoietin yang berperan penting dalam proses eritropoiesis. Kami melaporkan kasus seorang laki-laki 61 tahun dengan PGK hemodialisis disertai ko-infeksi hepatitis C namun dengan kadar hemoglobin dan eritropoietin normal. Pasien dinyatakan PGK sejak Maret 2014 dengan kadar hemoglobin (Hb) 9,9 g/dL; ureum 223 mg/dl; kreatinin 7,5 mg/dl, dan didukung oleh hasil ultrasonografi. Pasien diberikan hemodialisis dan terapi ESA pertama kali pada bulan April 2014. Terapi ESA terakhir diberikan pada bulan Juni 2015 dengan hasil serum iron 61 µg/dl, total iron binding capacity (TIBC) 173 µg/dl, feritin 1431 ng/ml, dan anti HCV kualitatif reaktif, Setelah itu pasien tidak mendapat terapi ESA lagi karena pada pemeriksaan laboratorium ditemukan kadar hemoglobin normal tanpa terapi ESA atau transfusi darah. Pemeriksaan kadar eritropoietin (EPO) pada bulan Desember 2018 mendapatkan hasil 16 mIU/ml (nilai normal 2,6-18,5 mIU/ml). Hingga saat ini pasien masih rutin menjalani hemodialisis dan tidak pernah mendapat terapi ESA atau transfusi darah. Keadaan tersebut jarang ditemukan, dan tidak ada patofisologi yang pasti untuk menjelaskan penyebab keadaan tersebut. Mekanisme keadaan ini dikaitkan dengan infeksi hepatitis C yang merangsang regenerasi hepatosit, sehingga sel-sel tersebut menghasilkan hormon ertiropoietin endogen, dengan hasil akhir ialah peningkatan hemoglobin.Kata kunci: penyakit ginjal kronik (PGK), kadar eritropoietin dan hemoglobin

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“…However, in many instances, the mechanism of erythrocytosis in ESRD patients is unknown. Renal EPO production is stimulated by decreased oxygen carrying capacity (hemoglobin concentration x O 2 saturation x cardiac output) [1–6]. Because the ability to secrete EPO is diminished in chronic kidney diseases, most ESRD patients require erythropoiesis-stimulating agents (ESA) to prevent anemia [7].…”

Section: Introductionmentioning

confidence: 99%

Erythrocytosis is associated with intradialytic hypotension: a case series

et al. 2019

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Background For patients with end stage renal disease undergoing hemodialysis, erythrocytosis occurs rarely. Erythrocytosis increases the risk of thrombosis, which is a common complication in hemodialysis patients. The risk of thrombosis may also be increased by hypotension. The purpose of our report is to examine the relationship between intradialytic hypotension and erythrocytosis. Case presentation We present a series of five patients with end stage renal disease and erythrocytosis (peak hemoglobin range 15.2–18.5 g/dL). All were erythropoiesis-stimulating agent naïve and non-smokers. Prior to developing erythrocytosis, each patient developed recurring episodes of intradialytic hypotension over several months. A statistically significant inverse correlation was observed between nadir intradialytic systolic blood pressure and hemoglobin concentration. In the index case, midodrine treatment resulted in resolution of the hypotension and erythrocytosis. Most of the patients had multiple acquired renal cysts, which is a potential source of erythropoietin. Four of the five cases developed arteriovenous dialysis access or deep venous thrombosis. Conclusions An association between intradialytic hypotension and erythrocytosis was observed in five cases. We postulate that chronic intermittent hypotension and renal ischemia may lead to erythropoietin secretion, and this cascade could represent a newly recognized cause of secondary erythrocytosis.

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Idiopathic Erythrocytosis in Dialysis Patients: A Case Report and Literature Review

Cited by 5 publications

References 17 publications

Idiopathic erythrocytosis in a patient on chronic hemodialysis

Idiopathic erythrocytosis in a patient on chronic hemodialysis

Gagal Ginjal Kronik Hemodialisis dengan Kadar Eritropoietin dan Hemoglobin Normal: Laporan Kasus

Erythrocytosis is associated with intradialytic hypotension: a case series

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