Professional Documents
Culture Documents
Thrombocytopenia
in Acute and Pembimbing
Failure
Penyusun :
Fransisca Nathalia Cindy K.
Akbar Dorgalaleh1, Mohammad Mahmudi2, Shadi Tabibian1, Zahra 406162130
Kashani Khatib1, GholamHossein Tamaddon3, Esmaeil Sanei
Moghaddam4, Taregh Bamedi5, Shaban Alizadeh1*, Eshagh Moradi6
JOURNAL READING
FAKULTAS KEDOKTERAN UNTAR
2018
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Journal Identity
Introduction
Renal failure -> kidneys are unable to adequately filter toxins
and waste products from the blood -> ↓ GFR
Acute renal failure (ARF) -> abrupt decline -> ↑ BUN, ↑ serum
ceratinine ↓ urine production
Trauma, hypovolemia, hypotension, CHF, sepsis,
nephrotoxins
Chronic renal failure (CRF) -> progressive loss -> ↑ creatinine, ↓
GFR
normochromic anemia, growth failure, nephritic syndrome,
HT, DM, kidney stone, glomerulonephritis and infection
Red cell production due to the Erythropoietin deficiency is too
low in CRF and causes development of anemia
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Methods
Case-control study
Conducted on 96 patients with ARF and 36 patients with
CRF, from February - April 2012 as case groups and two
groups of 97 and 82 individuals as controls.
Ethical approve and patients consent statement were
taken from everyone and the study was performed in
central hospital of Iranshahr.
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Methods
Methods
Group 1
• ARF (<3 month)
Group 2
• CRF (>3month)
Group 3 ( Control )
• No proven renal failure
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Methods
Methods
Results
Results
Results
Results
Discussion
Our study revealed that some red blood cell indices including RBC
count and Hb, HCT and MCHC levels were significantly lower in
patient group in comparison with healthy non renal affected
people(P<0.05) and anemia was considerable in patients with acute
renal failure.
The study of Michele Hales in 1994 described the presence of anemia
in 91% of patients with ARF ->↑ urea and oliguria. In their study 53
from 56 patients had a mild anemia (Ht < 35%) during their hospital
stay. This finding is compatible with our finding that a majority of our
patients (87.5%) with ARF.
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Discussion
43 of the patients had a Ht < 30%, not observed in our
patients and only 12.5 percent of patients had Ht <30%.
Michele Hales et al., found a significant correlation between
maximum serum urea and severity of anemia.
Our study also revealed that ARF did not cause significant
thrombocytopenia and even platelet count in these patients
were slightly higher in comparison to control group.
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Discussion
Patients with CRF were anemic and most RBC indices
including red blood cell count, Hb level, HCT concentration
and MCHC level were significantly lower in comparison with
the control group (P<0.05).
Compatible with a study by HW Radtke et al.(1979) ->
anemia was exaggerate during progression of renal
insufficiency in patients at different stages of chronic renal
failure.
Accordance with another study in 2004, the presence of
anemia in 47.7% of 5222 patients with chronic renal failure
before dialysis. ↑ anemia as kidney function ↓, and ↓GFR as
↑ anemia,we did not assess our patients from this aspect.
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Discussion
Platelet count was statistically significant lower than healthy
individuals (P<0.0001). Although the mean platelet (172.4×103/μl)
count did not show that our patients have not in a potential
bleeding risk.
Study of Gafter U et al., in 1987 was done on the platelet count in
55 patients with end-stage renal failure on maintenance
hemodialysis and in 19 predialysis patients with CRF before
hemodialysis. This study showed the decrease of platelet count
and mild thrombocytopenia in patients with CRF.
Another study 12/2009 - 2/2010, patients with renal failure are at
high risk of bleeding due to thrombocytopenia and platelet
dysfunction. In our study also we found a mild thrombocytopenia
among our patients but only 8% had a platelet count that would
put patients at risk of bleeding.
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Conclusion
Patients with acute and chronic renal failure revealed that severity of
anemia (HCT, Hb and MCV) were statistically high in comparison with
control groups (P>0.05) but thrombocytopenia in patients with chronic
renal failure was statistically different from control and the acute
ones (P<0.001).
It was recommended that in patients with chronic renal failure, to
prevent the risk of bleeding, platelet count should be checked
periodically.
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Critical Appraisal
Anemia and Thrombocytopenia in Acute
and Chronic Renal Failure
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
Judul Jurnal
Judul 9 kata <12
kata
Judul
menggambarkan isi
penelitian
Judul dibuat dengan
kalimat yang
sederhana
Tidak menggunakan
singkatan
Menggunakan
kalimat positif
Abstrak Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
PICO
Patient
• Patient with acute and chronic renal failure
Intervention
• 2 samples are taken from each patient, 2 ml
uncoagulated sample for biochemical assay and EDTA anti
coagulated whole blood sample for CBC
Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
PICO
Comparasion
• Patients with acute and chronic renal failure in
comparison with normal individuals
Outcome
Bukti Valid
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Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Hematology Oncology and Stem Cell Research. 7(4) - ijhoscr.tums.ac.ir – October 1, 2013
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