文档介绍：肾性贫血治疗指南
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 ）
贫血定义
WHO 贫血诊疗标准:
***女性血红蛋白（Hb）< 120 g/L
***男性 Hb < 130 g/L
但应考虑患者年纪、种族、居住地海拔高度和生理需求对Hb 影响。
注: 肾性贫血关键为促红细胞生成素不足造成, 只有以下各条内容均含有才能下临床诊疗:
①患者患有慢性肾脏病(CKD）, 并已经有肾功效损害;
② H b已达成上述贫血诊疗标准;
③能够除外C K D以外原因所致贫血。
注: EBPG及 K/DOQI均明确指出, 在评定贫血时, 检测H b浓度比检测H c t更轻易、更稳定、更可靠, 所以多年肾性贫血诊疗指南都再不用Hct诊疗贫血。
血液透析患者血标本应在血透开始前或刚开始血透时立即采集。
CPR . EVALUATION OF ANEMIA IN CKD
In the opinion of the Work Group, initial assessment of anemia should include the following tests:
A complete 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.
贫血试验室检验内容
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、总铁结协力、转铁蛋白饱和度、血清铁蛋白）
大便粪隐血试验。
注: 慢性肾脏病时贫血通常是正细胞和正色素性。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缺乏相关, 或者也可能是铁过多和(或) EP0 诊疗造成未成熟、大网织红细胞进入循环。
血清铁和转铁蛋白饱和度反应立即能够用作合成血红蛋白铁量。
血清铁蛋白反应了总机体内铁储存。
假如TSAT< 16％和(或)血清铁蛋白小于12 g／L则诊疗绝对铁缺乏。
肾性贫血检验步骤
CPG AND CPR . HB RANGE
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