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A 7 3-year-old man with anemia requiring transfusions for the past 3 mon ths presen ts for further evaluation . Leukocyte count is LJ ,900/ Jil, hemoglobin 7.9 g/dl, MCV 99 fl. platelet count 1 76,000/ Jil, and reticu locyte production index 0. 1 %. LDH is 1 82 U/L. On physical exam, he has no hepatosplenomegaly or lymphadenopathy. The peripheral blood smear is shown below.
What is the characteristic clinical finding in chronic renal disease patients on hemodialysis who develop antierythropoietin antibodies?
- Concurrent fall in platelets with worsening anemia
- Increasing thrombocytosis with worsening anemia
- Decrease in hemoglobin of 0.5 to 1 .0 g/ dL weekly or requirement of 1 to 2 units of blood transfusion per week
- Increasing lymphocytosis with worsening anemia
Medicine
C. Decrease in Hgb ofO.S to 1 .0 g/dL weekly or requirement of 1 to 2 units of blood transfu-sion per week, along with normal platelets (platelet count may decrease but is usually in the normal range) and normal white blood cell count, is characteristic of anti-EPO antibody-related anemia. A rise in serum ferritin due to the decreased utilization of iron is also seen (Eur J Haematol. 2004;73( 6):389).
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