文档介绍：肾性贫血治疗指南
1
2
3
CPR . IDENTIFYING PATIENTS AND INITIATING EVALUATION
Stage and cause of CKD: In the opinion of the Work Group, Hb testing should be carried out in all patients with CKD, regardless of stage or cause.
Frequency of testing for anemia: In the opinion of the Work Group, Hb levels should be measured at least annually.
Diagnosis of anemia: In the opinion of the Work Group, diagnosis of anemia should be made and further evaluation should be undertaken at the following Hb concentrations:
●< g/dL in adult males. ( g/dL )
●< g/dL in adult females. ( g/dL )
4
贫血定义
WHO 的贫血诊断标准:
***女性血红蛋白(Hb)< 120 g/L
***男性 Hb < 130 g/L
但应考虑患者年龄、种族、居住地的海拔高度和生理需求对Hb 的影响。
注:肾性贫血主要为促红细胞生成素不足导致,只有如下各条内容均具备才能下临床诊断:
①患者患有慢性肾脏病(CKD),并已有肾功能损害;
② H b已达到上述贫血诊断标准;
③能够除外C K D以外因素所致贫血。
注: 2004年EBPG及2006年K/DOQI均明确指出,在评估贫血时,检测H b浓度比检测H c t更容易、更稳定、更可靠,所以近年肾性贫血诊疗指南都再不用Hct诊断贫血。
血液透析患者血标本应在血透开始前或刚开始血透时即刻采集。
5
CPR . EVALUATION OF ANEMIA IN CKD
In the opinion of the Work Group, initial assessment of anemia should include the following tests:
plete blood count (CBC) including—in addition to the Hb concentration—red blood cell indices (mean corpuscular hemoglobin [MCH], mean corpuscular volume [MCV], mean corpuscular hemoglobin concentration [MCHC]), white blood cell count, and differential and platelet count.
Absolute reticulocyte count.
Serum ferritin to assess iron stores.
Serum TSAT or content of Hb in reticulocytes (CHr) to assess adequacy of iron for erythropoiesis.
6
贫血实验室检查内容
血红蛋白/红细胞压积(Hb/Hct)
红细胞指标(红细胞计数、平均红细胞体积、平均红细胞血红蛋白量、平均红细胞血红蛋白浓度等)
网织红细胞计数(有条件提倡检测网织红细胞血红蛋白量)
铁参数(血清铁、总铁结合力、转铁蛋白饱和度、血清铁蛋白)
大便粪隐血试验。
注:慢性肾脏病时的贫血一般是正细胞和正色素性的。小细胞性贫血说明存在铁缺乏、铝过多或某种血红蛋白病。
大细胞性贫血则可能与叶酸和维生素B12缺乏有关,或者也可能是铁过多和(或) EP0 治疗导致未成熟的、大的网织红细胞进入循环。
血清铁和转铁蛋白饱和度反映即刻可以用作合成血红蛋白的铁量。
血清铁蛋白反映了总的机体内铁储存。
如果TSAT< 16%和(或)血清铁蛋白小于12 g/L则诊断绝对铁缺乏。
7
肾性贫血的检查流程
8
CPG AND CPR . HB RANGE
Lower limit of Hb: In patients with CKD, Hb should b