1.

Anemia
Penurunan Hb :
- Mengindikasikan anemia. Penurunan Hb selalu diikuti dengan penurunan
hematokrit dan RBC (red blood cell, sel darah merah), tetapi belum tentu diikuti
dengan abnormalitas nilai MCV, MCH dan MCHC. Pada kasus di atas anemia
terjadi karena pasien mengalami CKD. Salah satu hormon yang penting pada
proses eritropoiesis di sumsum tulang adalah eritropoeitin yang diproduksi oleh
kelenjar adrenal pada ginjal. CKD mengakibatkan gangguan kelenjar adrenal
sehingga terjadi penurunan produksi eritropoetin.
- Penanganan anemia pada pasien CKD dengan pemberian tranfusi PRC
(packed red cell) atau pemberian hormon eritropoeitin. Pada kasus ini, PRC
baru diberikan tgl 16/6 dan 17/6, seharusnya PRC/eritropoeitin sudah diberikan
pada saat tanggal 14/6. Juga tidak ada pemeriksaan darah lengkap (DL) lagi
untuk mengetahui apakah anemia masih terjadi setelah pemberian PRC.

GFR mL/menit:

(140 − 𝑢𝑠𝑖𝑎) × 𝐵𝐵 (𝑘𝑔)

× 0,85
72 × 𝑆𝑐𝑟
(140−55) × 50 (𝑘𝑔)
72×9,27
× 0,85 = 5,41

Anemia occurs in acute and chronic renal failure. The anemia is usually normocytic but may
be microcytic. In renal failure, anemia occurs in part because uremic metabolites decrease the
lifespan of circulating red blood cells and reduce erythropoiesis.

Anemia secondary to uremia is characterized by inappropriately low erythropoietin levels, in

contrast to the normal or high levels that occur with most other causes of anemia. To further
confuse the presentation, serum iron levels and the percentage of iron saturation are often
low, apparently because of negative acute-phase reactions.10 Furthermore, the serum
creatinine level and the degree of anemia may not correlate well.3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458456/?report=reader

As kidney disease progresses, anemia increases in prevalence, affecting nearly all patients with stage
5 CKD.2 Anemia in CKD is associated with reduced quality of life and increased cardiovascular
disease, hospitalizations, cognitive impairment, and mortality.2 Anemia in CKD is typically
normocytic, normochromic, and hypoproliferative. The demonstration of a circulating factor
responsible for stimulating erythropoiesis, and the kidney as the main source of erythropoietin (EPO)
in the 1950s3,4 engendered the hypothesis that EPO deficiency is a predominant cause Journal of
the American Society of Nephrology : JASN

American Society of Nephrology

Mechanisms of Anemia in CKD

Jodie L. Babitt and Herbert Y. Lin

Additional article information

Abstract
Anemia is a common feature of CKD associated with poor outcomes. The current
management of patients with anemia in CKD is controversial, with recent clinical trials
demonstrating increased morbidity and mortality related to erythropoiesis stimulating agents.
Here, we examine recent insights into the molecular mechanisms underlying anemia of CKD.
These insights hold promise for the development of new diagnostic tests and therapies that
directly target the pathophysiologic processes underlying this form of anemia.

Anemia was first linked to CKD over 170 years ago by Richard Bright.1 As kidney disease
progresses, anemia increases in prevalence, affecting nearly all patients with stage 5 CKD.2
Anemia in CKD is associated with reduced quality of life and increased cardiovascular
disease, hospitalizations, cognitive impairment, and mortality.2

Anemia in CKD is typically normocytic, normochromic, and hypoproliferative. The

demonstration of a circulating factor responsible for stimulating erythropoiesis, and the
kidney as the main source of erythropoietin (EPO) in the 1950s3,4 engendered the hypothesis
that EPO deficiency is a predominant cause of anemia in CKD.