[Renaliste] [!!Mass Mail]Re: Dialyse et Taux D'hémoglobine spontanément superieur à 14 g

[Dr. Jorge Roman]

First let me apologize for answering in English; if against rules of Renaliste : please erase and excuse me.
Love French, can read it but writing beyond my abilities.

Over my almost 50 years of caring of dialysis patients have and do see quitre afew with "erythrocytosis" i.e. isolated Hb > 14-15 all other cell series normal.
Trusting my memory a rather weak organ at my age, I think more common since we adopted Sugar-Iron complexes rather than Dextran-iron ( used them much less for fear of anaphilaxis).
Currently have 4 patients out of 48 under my care with spontaneous Hb > 15. Is that common incidence??
AS far as management carefully avoid all iron; using iron deficiency as a control mechanism.
In a few after many months Hb drops < 11 then a little parenteral iron sucrose quickly raises Hb. Do not recall ever having to use ESA's due to poor response to iron.
All have been asyntomatic; no  Cerebro vascular accidents or access thrombosis.
Early on motivated by reports of occult hypernephromas we did renal ultrasounds; found only one but very obvious with gross hematuria and flank pain. Problem is that most long term dialysis patients have acquired cystic disease.
Try not to check hemoglobin post dialysis ; hemoconcentration can be dramatic.
On some have to use a frequent (every 30 minutes) quick saline flush ( 100 ml at 300 ml/min) to rinse extracorporeal circuit and try to control dialyzer fiber clogging by "thick blood".
If pre dialysis Hb > 16 instruct staff to discard all blood at the end of treatment; done 2-3 times seems to control hemoglobin.

This is one of the "Mysteries of Nephrology" that I fail to understand but are fascinating.

Again with my apologies for writing in wrong language; greatly enjoy Renaliste.

Jorge Roman-Latorre MD
Dallas Nephrology Associates
Dallas Texas USA


________________________________________
From: Renaliste [renaliste-bounces at nephrodial.org] on behalf of Saad fassi fihri [sfassifihri at gmail.com]
Sent: Friday, April 08, 2016 5:18 AM
To: Liste des néphrologues francophones
Subject: Re: [Renaliste]        [!!Mass Mail]Re: Dialyse et Taux D'hémoglobine spontanément superieur à 14 g

echographie rénale: dystrophie multikystique. faites vous la TDM systématiquement?

Le 8 avril 2016 à 07:00, GUILLODO MARIE-PAULE <marie-paule.guillodo at chu-brest.fr<mailto:marie-paule.guillodo at chu-brest.fr>> a écrit :
recherche systématique de dégénérescence kystique des reins propres faite ?


________________________________
De : Renaliste [renaliste-bounces at nephrodial.org<mailto:renaliste-bounces at nephrodial.org>] de la part de Saad fassi fihri [sfassifihri at gmail.com<mailto:sfassifihri at gmail.com>]
Envoyé : jeudi 7 avril 2016 22:25
À : Liste des néphrologues francophones
Objet : [!!Mass Mail]Re: [Renaliste] Dialyse et Taux D'hémoglobine spontanément superieur à 14 g

Pas d anomalies hématologiques associées

Le jeudi 7 avril 2016, miguel hotmail <mguillenanaya at hotmail.com<mailto:mguillenanaya at hotmail.com>> a écrit :
VGM normal ? Plaquette normale ? Formule Blanche normale ?
Un peu bas pour un début de Vaquez toutefois…

Bonne soirée, Dr Guillen



Le 7 avr. 2016 à 21:57, Saad fassi fihri <sfassifihri at gmail.com<http://UrlBlockedError.aspx>> a écrit :

Peut on fixer une valeur à ne pas dépasser?

Le jeudi 7 avril 2016, Philippe Nicoud <philippe.nicoud at wanadoo.fr<http://UrlBlockedError.aspx>> a écrit :
Bonsoir
Si ils sont sans Fer ni EPO on ne fait rien ils vont tout bien en règle générale
Nous en avons un ou deux sur 200 patients traités
Bonne soirée

Philippe Nicoud MD


> On 7 avr. 2016, at 3:06 PM, Saad fassi fihri <sfassifihri at gmail.com> wrote:
>
> Chers amis, je vous demande votre attitude devant les patients dialysés ayant  un taux d'HB supérieur à 14g, voir plus ( sans EPO), en dehors d'un arrêt du FER et de la recherche d'une cause paranéoplasique.
>
> Saad FASSI FIHRI
> Centre des maladies des reins souissi, Rabat
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