Inpatients with Vit [B.sub.12] values between 200 and 300pg per milliliter and in the presence of normal folic acid level, in lieu of estimation of Homocysteine and methylamalonic acid, ancillary evidences like
hypoproliferative anemia characterized by marked macrocytosis, hypersegmentation of neutrophils, pancytopenia, and signs of ineffective erythropoiesis (Such as elevated level LDH and indirect bilirubin) were assessed.
Anemia of chronic disease (ACD), also known as anemia of inflammation, is a
hypoproliferative anemia that develops in response to systemic illness or inflammation such as infection, cancer, and autoimmune conditions.
Erythropoietin response to anemia in children with sickle cell disease and Fanconi's
hypoproliferative anemia. Acta Haematol.
Chronic kidney disease is associated with
hypoproliferative anemia from failure to produce adequate amounts of the hormone to stimulate erythrocyte production in the bone marrow.
Renal failure is often associated with a decreased erythropoietin output resulting in
hypoproliferative anemia. In addition, a moderate degree of hemolysis and blood loss by various means plays an important role in decreasing red cell mass, which the bone marrow is unable to restore to normal.
The most extensively studied cytokines--tumor necrosis factor-[alpha], interleukin 1, interleukin 6, and interferon--contribute to
hypoproliferative anemia either by altering the sensitivity of erythroid precursors to Epoetin alfa or by stimulating the production of proinflammatory proteins such as C-reactive protein (CRP), fibrinogen, and serum amyloid A and decreasing levels of albumin and transferrin (Gunnell, Yeun, Depner, & Kaysen, 1999).
The primary cause of anemia seen in patients with CKD is from
hypoproliferative anemia (Barrett et al., 1999; Ly, Marticorena, & Donelly, 2004).
