Journal Reading

Anemia and
Thrombocytopenia
in Acute and Pembimbing
Chronic Renal Dr. Eddy Mulyono, Sp.PD, FINASIM
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
KEPANITERAAN KLINIK BAGIAN ILMU PENYAKIT DALAM
JOURNAL READING
FAKULTAS KEDOKTERAN UNTAR
RSUD RAA SOEWONDO PATI
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
 Title : Anemia and Thrombocytopenia in Acute and Chronic

Renal Failure
 Written by : Akbar Dorgalaleh, Mohammad Mahmudi, Shadi
Tabibian, Zahra Kashani Khatib, GholamHossein
Tamaddon, Esmaeil Sanei Moghaddam, Taregh Bamedi,
Shaban Alizadeh, and Eshagh Moradi
 Published by : International Journal of Hematology-
Oncology and Stem Cell Research
 Year : 2013
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
The Aim of this paper is :
1. To determined anemia situation and platelet count in

patients with acute renal failure.
2. To determined anemia situation and platelet count in
patients chronic renal.
3. To evaluate anemia situation and platelet count in
patients with acute and chronic renal failure in
comparison with normal individuals.
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.
Methods
Inclusion Criteria Exclusion Criteria
• patients with proven • Patients with

renal failure endocrinopathies,
anemia, and
hepatosplenomegaly
• patients with use of
certain drugs such as
heparin
Methods
Group 1
• ARF (<3 month)
Group 2
• CRF (>3month)
Group 3 ( Control )
• No proven renal failure
Methods
 During the study, no patient had blood, FFP, and platelet

transfusion.
 In order to eliminate effects of sex and age on comparison
between cases and control groups, were selected in each
pair of groups as similar as possible.
 Initially 2 blood samples were taken from each patient, 2
ml uncoagulated sample and EDTA anti coagulated.
 Serum -> BUN and creatinine, and EDTA samples -> CBC,
by Sysmex ( kx 21 Japan).
Methods
 Statistical analysis was done by SPSS software.

 Statistical independent t test was used to evaluate the
significance of differences between two groups. P<.05 was
considered as significant change.
Results
 In groups of patients with acute (49% male, 51% female)

and chronic (75% male, 25% female) renal failure mean
age were 58±15 and 60±11.5 years respectively.
 In control groups of acute (50% male, 50% female) and
chronic (76%male, 24% female) renal failure mean ages
were 59±12 and 60±12 years respectively.
Results
 The average level of BUN and creatinine in patients with

acute renal failure were 89±21 mg/dl and 2.9±0.9 mg/dl
and in control groups were 18±6 mg/dl and 1±0.4 mg/dl.
 In groups of chronic patients and control, the average of
BUN and creatinine were 84±25 mg/dl and 13.2±6 and
15±7 mg/dl and 1±0.14 mg/dl.
Results Anemia and Thrombocytopenia in Acute and Chronic Renal Failure. International Journal of
Results
 Comparison between ARF and the control group revealed

that RBC count, hemoglobin amount and hematocrit level
were significantly lower in the patient group than control
group (P<0.001) (Table 1).
Results
Results
 In patients with CRF -> RBC count, hemoglobin and

hematocrit level, MCHC and platelet count are
significantly lower than the control group (P<0.05) but
MCH and MCV levels are not significantly different
between these two groups (P>0.05) (Table 2).
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.
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.
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.
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.
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.
Critical Appraisal
Anemia and Thrombocytopenia in Acute
and Chronic Renal Failure
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
Mencakup komponen IMRD (Introduction, Methods, Result, Discussion)

Jumlah kata : 234 kata  < 250 kata
Hasil Penelitian
No. Kriteria Ya (+) Tidak (-)

1 Jumlah Subjek +
2 Tabel Karakteristik -
3 Tabel Hasil Penelitian +
4 Komentar dan Pendapat Penulis +
tentang hasil
Kesimpulan dan Daftar Pustaka
No. Kriteria Ya (+) Tidak (+)
1 Pembahasan dan kesimpulan terpisah -
2 Pembahasan dan kesimpulan di +
paparkan dengan jelas
3 Pembahasan mengacu dari penelitian +
sebelumnya
4 Pembahasan sesuai dengan landasan +
teori
5 Keterbatasan Penelitian -
6 Simpulan berdasarkan penelitian +
7 Saran Penelitian +
8 Penulisan Daftar Pustaka sesuai aturan +
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
PICO
Comparasion
• Patients with acute and chronic renal failure in
comparison with normal individuals
Outcome
• Patients with acute and chronic renal failure revealed

that severity of anemia were statistically high in
comparison with control groups
Bukti Valid
Pertanyaan Ya/ Tidak
Apakah alokasi pasien pada penelitian ini dilakukan
Tidak
secara acak?
Apakah pengamatan pasien dilakukan secara
Ya
lengkap?
Apakah semua pasien dalam kelompok dianalisis? Ya
Apakah pasien dan dokter tetap blind dalam
Tidak
mengambilan data penelitian?
Apakah kelompok diperlakukan sama selain dari
Ya
terapi yang diuji?
Applicability
APPLICABLE Ya/ Tidak
Apakah pada pasien kita terdapat perbedaan
bila dibandingkan dengan yang terdapat pada
Tidak
penelitian sebelumnya sehingga hasil tersebut
tidak dapat diterapkan pada pasien kita?
Apakah pemberian terapi tersebut mungkin
Ya
dapat diterapkan pada pasien kita?
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Anemia and

Chronic Renal Dr. Eddy Mulyono, Sp.PD, FINASIM

KEPANITERAAN KLINIK BAGIAN ILMU PENYAKIT DALAM

RSUD RAA SOEWONDO PATI

 Title : Anemia and Thrombocytopenia in Acute and Chronic

The Aim of this paper is :

1. To determined anemia situation and platelet count in

Inclusion Criteria Exclusion Criteria

• patients with proven • Patients with

 During the study, no patient had blood, FFP, and platelet

 Statistical analysis was done by SPSS software.

 In groups of patients with acute (49% male, 51% female)

 The average level of BUN and creatinine in patients with

 Comparison between ARF and the control group revealed

 In patients with CRF -> RBC count, hemoglobin and

Mencakup komponen IMRD (Introduction, Methods, Result, Discussion)

No. Kriteria Ya (+) Tidak (-)

• Patients with acute and chronic renal failure revealed

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