Can Huzmeli
Necip Fazıl City Hospital, Turkey
Title: Erythropoietin resistance from failed renal allograft: Case report
Biography
Biography: Can Huzmeli
Abstract
The reason of anaemia during chronic renal insufficiency is deficiency of erythropoietin (ESA). Risk factors for ESA resistance are absolute or functional iron deficiency, gastrointestinal blood loss, haemolysis, inflammation, infection, malignancy, folic acid and vitamin B12 deficiency, inadequate haemodialysis, hyperparathyroidisim, Angiotensin converting enzyme inhibitor, Angiotensin II receptor blocker, Anti-erythropoietin antibody and genetic polymorphism. We describe a case of 52 year old man who had a history of renal allograft failure. Three moons later he presented to the hospital with symptoms of severe anemia, hematuria, fever, exhaustion and fatigue. Due to deep anaemia, 5 times in 2 months (2U each time) erythrocyte replacement (ES) was performed. There was sensitivity in the graft site. Laboratory examinations were: Hb 5.4 gr/dl (13-17), albumin 2.2 gr/dl (3.5-5.2), ferritin >2000 ng/ml (30-100), transferrin saturate was calculated as 40%, vitamin B12 402 pg/ml (191-663), parathormon 630 pg/ml (15-65), C-reactive protein 117 mg/L (0-5), sedimentation 70 mm/hour. In the conducted peripheral spread, normochromic was compatible with normocytic anaemia. The patient was taking epoetin beta 150 Ü/kg vitamin D in treatment, upon no detection of reproduction in sent blood, urine and sputum cultures. Methylprednisolone (10 mg) was started with Graft intolerance syndrome (GIS) diagnosis. Patient did not have fever and did not need ES in his medical follow-ups. GIS was successfully treated with low dose steroids despite the suggestion of high dose steroids. After treatment, Hb level exceeded 12 gr/dl and he did not need erythropoetin.