Haematological aspects of renal disease

Renal diseases are associated with a variety of haemopoietic changes. Anaemia parallels the degree of renal impairment and its most important cause is failure of renal erythropoietin secretion. Other factors include depressed red cell production and reduced red cell survival. Purpura and bleeding are predominantly due to platelet dysfunction and usually respond to dialysis. Cryoprecipitate and 1-deamino-8-d-arginine vasopressin may be of value in the bleeding patient. Abnormal coagulation with fibrin deposition in the microcirculation is now recognised as a mechanism of renal impairment. Plasma infusion and anticoagulants may be useful in the therapy of conditions in which this occurs. Plasma exchange is now used in the investigation and management of some varieties of immunologically mediated renal disease. Blood transfusion has been found to improve graft survival if given prior to renal transplantation and this effect is currently under active investigation.