Hypochromic anaemia in chronic renal failure--role of aluminium

Anaemia is a cardinal feature of chronic renal failure and classically it is normochromic normocytic. Hypochromic anaemia in these patients is often attributed to iron deficiency.

This study was aimed to find the contribution of aluminium in causation of anaemia in CRF patients.

Dialysis dependent patients of chronic renal failure with adequate dietary intake (> 1500 Cals/day) and no apparent source of blood loss were evaluated for type of anaemia. (During period of this study centre didn't have reverse osmosis plant for water treatment). Evaluation included upper GI endoscopy, complete hemogram, serum proteins, serum iron, total iron binding capacity, and bone marrow iron status. For aluminium evaluation serum aluminium levels were done.

Sixty-four patients were evaluated for type of anaemia. Mean age of patients was 41.19 years (15-76 years) with male:female ratio 2.3:1. Classical normochromic picture was seen in 28.5% while rest had hypochromic picture. On bone marrow aspiration study two patients had zero iron stores while all others had normal/excessive iron stores. In 10 patients with hypochromic picture, mean serum aluminium levels were 170 micrograms/L (30-310 micrograms/L).

This study highlights the high prevalence of hypochromic anaemia in patients with adequate dietary intake and aluminium overload in Indian CRF patients.