Review Note

A 52-year-old African-American diabetic requires hemodialysis for end-stage renal disease. She has hemoglobin of 9, hematocrit of 27, and normal red cell indices. The iron and iron-binding capacity are normal. Her peripheral blood smear is unremarkable, What is the most probable diagnosis?

• Iron-deficiency anemia
• Anemia of renal disease
• Anemia of chronic disease
• Folate deficiency
• Microangiopathic hemolytic anemia
  

Anemia of renal disease

The anemia of renal disease is normocytic and normochromic, as are most anemias associated with bone marrow production problems (aplastic anemia, leukemia) and most hemoglobinopathies. In renal failure, the red cells themselves are normal but are not stimulated to proliferate because of inadequate amounts of erythropoietin. White cell and platelet counts are usually normal, although there are disorders of function in both these cell lines. This anemia responds to erythropoietin supplementation.

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