Abstract
The resistance to erythropoietin, which is used to treat normochromic, normocytic anemia in chronic renal failure, can develop in patients with conditions such as iron deficiency, aluminum toxicity, hyperparathyroidism, chronic inflammatory diseases, and primary hematological disorders. We found amyloidosis in the bone marrow of a woman without any other etiology for erythropoietin resistance who was undergoing chronic hemodialysis. Her anemia did not improve, despite 6 months of erythropoietin therapy. Bone marrow amyloidosis was found to be the reason for erythropoietin-resistant anemia in our patient with chronic renal failure and renal anemia. We present the case of bone marrow amyloidosis because it is a very rare cause of erythropoietin resistance.
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References
References 1. Eschbach JW, Adamson JW. Anemia of end-stage renal disease (ESRD). Kidney Int 1985; 28: 1–5.EschbachJW]]AdamsonJWAnemia of end-stage renal disease (ESRD)Kidney Int1985281 2. Rao DS, Shih MS, Mohini R. Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med 1993; 328: 171–175.RaoDS]]ShihMS]]MohiniREffect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremiaN Engl J Med1993328171 3. Grutzmacher P, Ehmer B, Limbach J, Messinger D, Kulbe KD, Scigalla P. Treatment with recombinant human erythropoietin in patients with aluminum overload and hyperparathyroidism. Blood Purif 1990; 8: 279–284.GrutzmacherP]]EhmerB]]LimbachJ]]MessingerD]]KulbeKD]]ScigallaPTreatment with recombinant human erythropoietin in patients with aluminum overload and hyperparathyroidismBlood Purif19908279 4. Steffen HM, Brunner R, Muller R, Degenhardt S, Pollok M, Lang R, et al. Peripheral hemodynamics, blood viscosity, and the renin-angiotensin system in hemodialysis patients under therapy with recombinant human erythropoietin. Contrib Nephrol 1989; 76: 292–298.SteffenHM]]BrunnerR]]MullerR]]DegenhardtS]]PollokM]]LangRPeripheral hemodynamics, blood viscosity, and the renin-angiotensin system in hemodialysis patients under therapy with recombinant human erythropoietinContrib Nephrol198976292 5. Rosenlof K, Fyhrquist F, Tenhunen R. Erythropoietin, aluminium, and anaemia in patients on haemodialysis. Lancet 1990; 335: 247–249.RosenlofK]]FyhrquistF]]TenhunenRErythropoietin, aluminium, and anaemia in patients on haemodialysisLancet1990335247 6. Muirhead N, Hodsman AB, Hollomby DJ, Cordy PE. The role of aluminium and parathyroid hormone in erythropoietin resistance in haemodialysis patients. Nephrol Dial Transplant 1991; 6: 342–345.MuirheadN]]HodsmanAB]]HollombyDJ]]CordyPEThe role of aluminium and parathyroid hormone in erythropoietin resistance in haemodialysis patientsNephrol Dial Transplant19916342 7. Grutzmacher P, Ehmer B, Messinger D, Kulbe KD, Scigalla P. Effect of aluminum overload on the bone marrow response to recombinant human erythropoietin. Contrib Nephrol 1989; 76: 315–323.GrutzmacherP]]EhmerB]]MessingerD]]KulbeKD]]ScigallaPEffect of aluminum overload on the bone marrow response to recombinant human erythropoietinContrib Nephrol198976315 8. Eschbach JW, Abdulhadi MH, Browne JK, Delano BG, Downing MR, Egrie JC, et al. Recombinant human erythropoietin in anemic patients with end-stage renal disease: Results of a Phase III multicenter clinical trial. Ann Intern Med 1989; 111: 992–1000.EschbachJW]]AbdulhadiMH]]BrowneJK]]DelanoBG]]DowningMR]]EgrieJCRecombinant human erythropoietin in anemic patients with end-stage renal disease: Results of a Phase III multicenter clinical trialAnn Intern Med1989111992 9. Sungur C, Sungur A, Ruacan S, Arik N, Yasavul U, Turgan C, et al. Diagnostic value of bone marrow biopsy in patients with renal disease secondary to familial Mediterranean fever. Kidney Int 1993; 44: 834–836.SungurC]]SungurA]]RuacanS]]ArikN]]YasavulU]]TurganCDiagnostic value of bone marrow biopsy in patients with renal disease secondary to familial Mediterranean feverKidney Int199344834 &NA; The Don Quixote of one generation May live to hear himself called The savior of society by the next.—James Russell Lowell
