Nephrology case no1.CKD

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Complain: Excessive tiredness. Complain: Excessive tiredness. how to treat CKD Anemia?

CBC- TSH, urine R/E and serum creatinine করা হলো

Hb- level 8.5 mg/dl

MCV, MCHC, MCH, সব নরমাল,

Tar age amra janbo mcv ki ?

What is mean corpuscular volume (MCV)?

Mean corpuscular volume (MCV) is a value calculated during a routine blood test called a Complete Blood count. MCV measures the average size of your Red blood cells. Your red blood cells carry oxygen throughout your body. This oxygen, in turn, powers your cells. The characteristics of your red blood cells — including size — provide information about how successfully they can transport oxygen.

An MCV blood test is helpful because having a large number of atypically large or atypically small red blood cells can indicate certain conditions. It’s less helpful if you have a wide variety of red blood cell sizes in a blood sample. In that case, even if there’s an abnormality, the numbers may average out as normal.

An MCV is routinely performed by an automated machine on all CBCs. It’s included on the portion of the CBC that provides information on your red blood cells in particular, called the RBC (red blood cell) indices.

RBC indices include the following measurements: Treatment of iron deficiency anemia in ckd

Mean corpuscular volume (MCV): The average size of your red blood cells.
Mean corpuscular hemoglobin (MCH): The average amount of hemoglobin in your red blood cells. Hemoglobin is an important protein that allows red blood cells to carry oxygen.
Mean corpuscular hemoglobin concentration (MCHC): The average amount of hemoglobin concentration in your red blood cells.
Red cell distribution width ( RDW): How varied in size your red blood cells are.

An MCV alone doesn’t provide enough information for a diagnosis. When considered alongside these other tests, an MCV blood test can help your provider learn more about the health of your red blood cells and diagnose conditions.

When is an MCV blood test performed?

An MCV blood test is routinely performed during a CBC.

What level of MCV is concerning?

Low MCV

Low MCV (microsytosis ) is less than 80 fl. It may be a sign of:

Iron deficiency Anemia.
Thalassemia .
Other hemoglobin disorders.

High MCV

High MCV (Macrocytosis ) is greater than 100 fl. It may be a sign of:

Pernicious Anemia
Vitamin Deficiency Anemia.
Floate Deficiency
Liver Disease
Bone marrow dysfunction, as in myelodysplastic Syndrome.

Chemotherapy treatments may also cause you to have elevated MCV.

What is MCHC In blood ?

Answer is:- Mean corpuscular hemoglobin concentration (MCHC)

What does the test MCHC measure?

Answer is:-The MCHC test measures the concentration of hemoglobin in a RBC relative to the size of the cell itself. MCHC is a calculation that helps describe how much space inside of each RBC is made of hemoglobin.

A protein carried by RBC and that plays a vital role in supporting overall health, hemoglobin delivers oxygen to organs and tissues throughout the body. It also transports carbon dioxide back to the lungs where it can be exhaled.

What is purpose of test MCHC?

Answer is :-Purpose of the test mchc?

The purpose of an MCHC test is to evaluate whether RBC are carrying an appropriate amount of hemoglobin. MCHC is one of several measurements used to assess the function and health of RBC to check for signs of anemia and other blood disorders.

The MCHC test is one of the RBC indices, a collection of tests that provide information about certain characteristics of RBC like their size, shape, and quality. RBC indices are part of a Complete blood count (cbc) which collectively include:

Mean corpuscular hemoglobin (MCH)
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin concentration (MCHC)
Red blood cell distribution width (RDW)

What is the normal valu of MCHC Test ?

Answer is:-The results of MCHC and the other RBC indices are used to diagnose and classify different types of anemia.

The normal range for MCHC is 32 to 36 grams per deciliter (g/dL) or 320 to 360 grams per liter (g/L). Since different laboratories might use different measurements or blood samples, you should talk with your healthcare provider about what a normal range is for you.⁴

A low MCHC measurement is known as hypochromia. It indicates that you have a lower concentration of hemoglobin in your red blood cells. Having less hemoglobin reduces your blood’s capacity to carry oxygen to your organs and tissues.
A high MCHC measurement is known as hyperchromia. It indicates that you have a higher concentration of hemoglobin in your red blood cells. This can increase your chances of developing various health complications such as blood clots.

What is the Causes of Low MCHC?

Answer is :-

MCHC levels below the normal range can be a sign of Iron deficiency anemia . Iron deficiency anemia develops when you don’t have enough iron in your body, which you need to make red blood cells. A lack of iron can impact the production of healthy red blood cells and, thus, your MCHC levels.⁶

Iron deficiency anemia is the most common type of anemia. It can develop when there is:⁶

Chronic inflammation: Conditions that cause long-lasting inflammation can make it hard for your body to use iron.
Kidney disease: With this, your kidneys don’t make enough erythropoietin, a hormone needed to make red blood cells.
Trouble absorbing iron: This can be the effect of endurance sports, digestive conditions, and certain genetic conditions.

Low MCHC can also be due to thalassemia. Thalassemia is an inherited blood disorder in which the body does not make enough hemoglobin.⁷

It can also be due to Pancytopenia , which is a combination of your body not producing enough red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia).

An MCHC that is below or above the normal range can develop for a number of reasons.

What is cause of high volume of MCHC ?

Answer is:-

Causes of High MCHC

A high MCHC can also be due to anemia, depending on the type of anemia you have. Hemolytic anemia may lead to an MCHC measurement above the normal range.¹ Hemolytic anemia develops when red blood cells break down faster than they can be replaced.⁸ This type of anemia can happen for several reasons, including:

Autoimmune Conditions
Blood transfusion complications
Infections
Sickle cell disease

Higher-than-normal MCHC results may also be attributable to hereditary spherocytosis, a rare genetic condition in which the body makes abnormally shaped red blood cells.

What is MCH In blood ?

Answer is:- Mean corpuscular hemoglobin, or MCH, is a value on a routine Blood test called a Complete blood count (CBC). It measures the average (“mean”) amount of hemoglobin you have per red blood cell Hemoglobin is an essential protein in your red blood cells that allows them to do their main job: Carry oxygen throughout your body. The oxygen powers your cells and keeps your body functioning.

MCH is just one value on a complete blood count that provides information about your red blood cells. This part of the CBC is called the RBC indices. Other values on the RBC indices include:

Mean corpuscular volume (MCV): Measures the average size of your red blood cells.

When is MCH on a blood test needed?

MCH is a standard part of a CBC, which checks the health of your red blood cells White blood cell and platelets MCH — like all values on a CBC — helps healthcare providers catch signs of a condition early.

MCH values are especially useful for your provider to know about if you have symptoms of anemia, like Fatique or frequent Headaches. Considered alongside the other RBC indices, an abnormal MCH can help your provider determine whether you have anemia. It can also help them determine what’s likely causing it.

What is the cause of low MCH?

Answer is:- Low MCH

A low MCH may mean that you may have hypochromic anemia (when your red blood cells are paler than normal) and/or Microcytic anemia (when your red blood cells are abnormally small). With both conditions, your red blood cells don’t have enough hemoglobin.

Causes of low MCH include:

Iron deficiency: Having too little iron can prevent your body from making enough hemoglobin. The most common cause of iron deficiency anemia is blood loss. It can happen because of heavy period bleeding, internal bleeding or excessive bleeding after surgery.
Hemoglobinopathies: Some blood disorders can cause problems with how your body makes hemoglobin. Examples include Thalassemia and Sickle cell anemia.
Inflammation associated with chronic (long-term) conditions: Long-term infections,kidney disease,Liver disease and cancer can lead to inflammation that causes low MCH.

What is the cause of high volume MCH?

Answer is:- High MCH

A high MCH may mean that you have Macrocytic anemia. With macrocytic anemia, your body produces abnormally large red blood cells that contain high levels of hemoglobin. Often, it happens because your body isn’t getting enough of the key ingredients needed to make healthy RBCs: Floate of vitamin B12. Or you have a condition that prevents your body from absorbing these nutrients.

Causes of elevated MCH include:

Long-term Alcohol use disorder .
Problems with your Thyroid disorder.
Medication or treatment side effects. (For example, high MCV may be a side effect of Chemtherapy.)

serum creatinine : 280 mg/dl

এখন কি করবেন?

এইটা কোন ধরণের anaemia

Dx- CKD

Next step – investigation of Hematinics

ferritin, B12 and folate,

CKD তে B12 and folate deficiency rarely, তাও যদি deficiency থাকে, তা কারেকশন করে নিবে,…

Serum ferritin er Normal value 20-250 microgram/L

এখন যদি পেশেন্ট এর সেরাম ফেরিটিন ২০০ এর উপরে থাকে, তাহলে এই পেশেন্ট কে সরাসরি EPO দেওয়া হবে—

কোনো আয়রণ সাপ্লিমেন্ট এর দরকার নাই,

আর যদি ferritin 200 এর কম থাকে, তাহলে তাকে আগে আয়রণ সাপ্লিমেন্ট দেওয়া হবে, আয়রণ ২০০ এর উপরে গেলে তারপর Erythropoitine দেওয়া হবে.

Treatment Management :-

Injection1:-Epoetin IV/SC 10000 IU Pre filled syringe . (AS A Erythropoietin Alfa Drugs for Haemolytic Hypoplastic & Renal Anemia).

Indications of Epoetin injection:-

Epoetin is an erythropoiesis-stimulating agent (ESA) indicated for:

Treatment of anemia due to:

Chronic Kidney Disease (CKD) in patients on dialysis and not on dialysis.
Zidovudine in HIV-infected patients.
The effects of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned chemotherapy.

Reduction of allogeneic RBC transfusions in patients undergoing elective, noncardiac, nonvascular surgery.

Prevention of anemia of prematurity in infants with a birth weight of 750 to 1500 gm and gestational age of less than 34 weeks.

Side Effects of Epoetin Injection:-

Adverse reactions in 5% of Epoetin treated patients in clinical studies were:

Patients with CKD: Hypertension, arthralgia, muscle spasm, pyrexia, dizziness, medical device malfunction, vascular occlusion, and upper respiratory tract infection.
Zidovudine-treated HIV-infected Patients: Pyrexia, cough, rash, and injection site irritation.
Cancer Patients on Chemotherapy: Nausea, vomiting, myalgia, arthralgia, stomatitis, cough, weight decrease, leukopenia, bone pain, rash, hyperglycemia, headache, depression, dysphagia, hypokalemia, and thrombosis.
Surgery Patients: Nausea, vomiting, pruritus, headache, injection site pain, chills, deep vein thrombosis, cough, and hypertension.
Premature infants: A fall in serum ferritin values is very common (>10%)

1.What is EPO?

Answer is:-Erythropoietin (EPO) is a glycoprotein hormone produced by the peritubular cells of the renal cortex. This hormone stimulates red blood cell production in response to low partial pressure of oxygen

2.What are EPO injections used for?

Answer is:-Epoetin alfa injection products are used to treat anemia (a lower than normal number of red blood cells) in people with chronic kidney failure (condition in which the kidneys slowly and permanently stop working over a period of time).

3.What is a EPO blood test for?

Answer is:-This test may be used to help determine the cause of anemia, polycythemia (high red blood cell count) or other bone marrow disorders. A change in red blood cells will affect the release of EPO. For example, people with anemia have too few red blood cells, so more EPO is produced.

Raiyyan Tahsan

CBC- TSH, urine R/E and serum creatinine করা হলো

Hb- level 8.5 mg/dl

MCV, MCHC, MCH, সব নরমাল,

Tar age amra janbo mcv ki ?

What is mean corpuscular volume (MCV)?

RBC indices include the following measurements:

Mean corpuscular volume (MCV): The average size of your red blood cells.
Mean corpuscular hemoglobin (MCH): The average amount of hemoglobin in your red blood cells. Hemoglobin is an important protein that allows red blood cells to carry oxygen.
Mean corpuscular hemoglobin concentration (MCHC): The average amount of hemoglobin concentration in your red blood cells.
Red cell distribution width ( RDW): How varied in size your red blood cells are.

When is an MCV blood test performed?

An MCV blood test is routinely performed during a CBC.

What level of MCV is concerning?

Low MCV

Low MCV (microsytosis ) is less than 80 fl. It may be a sign of:

Iron deficiency Anemia.
Thalassemia .
Other hemoglobin disorders.

High MCV

High MCV (Macrocytosis ) is greater than 100 fl. It may be a sign of:

Pernicious Anemia
Vitamin Deficiency Anemia.
Floate Deficiency
Liver Disease
Bone marrow dysfunction, as in myelodysplastic Syndrome.

Chemotherapy treatments may also cause you to have elevated MCV.

What is MCHC In blood ?

Answer is:- Mean corpuscular hemoglobin concentration (MCHC)

What does the test MCHC measure?

What is purpose of test MCHC?

Answer is :-Purpose of the test mchc?

Mean corpuscular hemoglobin (MCH)
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin concentration (MCHC)
Red blood cell distribution width (RDW)

What is the normal valu of MCHC Test ?

Answer is:-The results of MCHC and the other RBC indices are used to diagnose and classify different types of anemia.

A low MCHC measurement is known as hypochromia. It indicates that you have a lower concentration of hemoglobin in your red blood cells. Having less hemoglobin reduces your blood’s capacity to carry oxygen to your organs and tissues.
A high MCHC measurement is known as hyperchromia. It indicates that you have a higher concentration of hemoglobin in your red blood cells. This can increase your chances of developing various health complications such as blood clots.

What is the Causes of Low MCHC?

Answer is :-

Iron deficiency anemia is the most common type of anemia. It can develop when there is:⁶

Chronic inflammation: Conditions that cause long-lasting inflammation can make it hard for your body to use iron.
Kidney disease: With this, your kidneys don’t make enough erythropoietin, a hormone needed to make red blood cells.
Trouble absorbing iron: This can be the effect of endurance sports, digestive conditions, and certain genetic conditions.

Low MCHC can also be due to thalassemia. Thalassemia is an inherited blood disorder in which the body does not make enough hemoglobin.⁷

It can also be due to Pancytopenia , which is a combination of your body not producing enough red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia).

An MCHC that is below or above the normal range can develop for a number of reasons.

What is cause of high volume of MCHC ?

Answer is:-

Causes of High MCHC :-

Autoimmune Conditions
Blood transfusion complications
Infections
Sickle cell disease

Higher-than-normal MCHC results may also be attributable to hereditary spherocytosis, a rare genetic condition in which the body makes abnormally shaped red blood cells.

What is MCH In blood ?

MCH is just one value on a complete blood count that provides information about your red blood cells. This part of the CBC is called the RBC indices. Other values on the RBC indices include:

Mean corpuscular volume (MCV): Measures the average size of your red blood cells.

When is MCH on a blood test needed?

What is the cause of low MCH?

Answer is:- Low MCH cause:-

Causes of low MCH include:

Iron deficiency: Having too little iron can prevent your body from making enough hemoglobin. The most common cause of iron deficiency anemia is blood loss. It can happen because of heavy period bleeding, internal bleeding or excessive bleeding after surgery.
Hemoglobinopathies: Some blood disorders can cause problems with how your body makes hemoglobin. Examples include Thalassemia and Sickle cell anemia.
Inflammation associated with chronic (long-term) conditions: Long-term infections,kidney disease,Liver disease and cancer can lead to inflammation that causes low MCH.

What is the cause of high volume MCH?

Answer is:- High MCH

Causes of elevated MCH include:

Long-term Alcohol use disorder .
Problems with your Thyroid disorder.
Medication or treatment side effects. (For example, high MCV may be a side effect of Chemtherapy.)

serum creatinine : 280 mg/dl

এখন কি করবেন?

এইটা কোন ধরণের anaemia

Dx- CKD

Next step – investigation of Hematinics

ferritin, B12 and folate,

CKD তে B12 and folate deficiency rarely, তাও যদি deficiency থাকে, তা কারেকশন করে নিবে,…

Serum ferritin er Normal value 20-250 microgram/L

কোনো আয়রণ সাপ্লিমেন্ট এর দরকার নাই,

Treatment Management :-

Injection1:-Epoetin IV/SC 10000 IU Pre filled syringe . (AS A Erythropoietin Alfa Drugs for Haemolytic Hypoplastic & Renal Anemia).

Indications of Epoetin injection:-

Epoetin is an erythropoiesis-stimulating agent (ESA) indicated for:

Treatment of anemia due to:

Chronic Kidney Disease (CKD) in patients on dialysis and not on dialysis.
Zidovudine in HIV-infected patients.
The effects of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned chemotherapy.

Side Effects of Epoetin Injection:-

Adverse reactions in 5% of Epoetin treated patients in clinical studies were:

Patients with CKD: Hypertension, arthralgia, muscle spasm, pyrexia, dizziness, medical device malfunction, vascular occlusion, and upper respiratory tract infection.
Zidovudine-treated HIV-infected Patients: Pyrexia, cough, rash, and injection site irritation.
Cancer Patients on Chemotherapy: Nausea, vomiting, myalgia, arthralgia, stomatitis, cough, weight decrease, leukopenia, bone pain, rash, hyperglycemia, headache, depression, dysphagia, hypokalemia, and thrombosis.
Surgery Patients: Nausea, vomiting, pruritus, headache, injection site pain, chills, deep vein thrombosis, cough, and hypertension.
Premature infants: A fall in serum ferritin values is very common (>10%)

1.What is EPO?

2.What are EPO injections used for?

3.What is a EPO blood test for?

Raiyyan Tahsan date:30-10-24.wednesday at 11.26AM

Raiyyan Tahsan

Raiyyan Tahsan