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1.   認識腎性貧血/Understanding Renal Anemia  2018.06.27

『腎性貧血』是慢性腎功能衰竭病人的一種特有症狀,它與腎功能損害的程度有相關性。

一、腎性貧血的原因:
腎臟病人貧血的主要原因是紅血球生成素(EPO)產量減少。EPO是由腎臟製造,當腎臟功能逐步退化,其產量會減少。EPO的功能是在刺激骨髓產生紅血球。

二、腎性貧血其他常見因素:
1.鐵質缺乏。
2.葉酸及維他命缺乏。
3.營養不良。
4.副甲狀腺功能亢進:造成骨質纖維化
5.感染或炎症反應…等,只是一個小感冒,都有可能使血色素急速降低。
6.血液由腸道流失(例如解黑便或血便)。
7.血液透析中血液流失。
8.紅血球的壽命減少:正常紅血球的壽命約120天,腎臟衰竭病人因體內毒素增高容易產生溶血其紅血球壽命會減少。
上述因素應由醫師判斷與處理,不應自行補充不當的營養素或健康食品。
若要服用,請先與您的主治醫師討論。

三、腎性貧血症狀:
疲勞、嗜睡、食慾降低、運動能力減少、有時候上氣不接下氣的症狀。

四、腎性貧血的處理:
正常的血紅素值是14-17g/dL,慢性腎衰竭病人血紅素值會降到10g/dL以下,隨著病人腎功能下降狀況,血紅素值也會隨著變化,甚至低到7-8g/dL以下。其原因最常見的是紅血球生成素減少,因此紅血球生成素(EPO)的補充是最常見、最有效的治療,其次為鐵質、葉酸、維他命B12缺乏性貧血,視情況需要時醫師會給予治療。腎性貧血治療目標:血紅素10g/dL以上,若達11-12g/dL更佳。

五、『紅血球生成素EPO』用藥須知:
1.用藥方法:依醫囑以注射方式給予。
2.保存方法:冰箱2~8℃冷藏。
3.副作用:高血壓、腹瀉、高血鉀…等。其中以高血壓最常見,因此病人在使用EPO時,應定時測量血壓。
4.影響EPO治療效果不佳的原因包含:尿毒素增高、鐵質缺乏、感染/發炎、慢性血液流失、葉酸或維他命B12缺乏、營養不良…等。都有可能影響身體對EPO的效果。

六、問與答:

問(一):腎性貧血可以補充「補血」製品或營養食品嗎?
答:貧血正確的處理方法,是先經醫師正確診斷,確定貧血是何種原因引起,再決定治療與處理方法,不能盲目補充營養食品、維他命或補血製品(鐵劑),對身體反而有害,因此補充時要很小心,請先諮詢醫師的建議。

問(二):腎性貧血,如何食補?可用雞湯、豬肝當作食補嗎?
答:可選用紅肉:牛肉、羊肉、豬肉、鴨肉,鴨血、豬血、深綠色蔬菜、葡萄、蘋果、水梨、櫻桃等含有豐富鐵質、葉酸及維生素B12,可諮詢醫護人員或營養師可攝取的量。不建議雞湯、豬肝當作食補方式。

自我評量(是非題)
( )1. 腎性貧血其他常見因素:鐵質缺乏、葉酸缺乏、血液由腸道流失等,應由醫師判斷和處理,勿自行購買健康食品使用。
( )2. 慢性腎臟病病人貧血可以食用雞湯、豬肝當作食補。

參考資料:
唐德成、洪思群(2015).腎性貧血.於許志成總校閱,2015台灣慢性腎臟病臨床診療指引(一版,390-409頁).台北市:財團法人國家衛生研究院。
郭宜瑾、洪啟智、陳鴻鈞(2013).慢性腎臟病貧血診斷與治療的新進展.內科學誌,24 (3),278-287。
制定日期:2006年7月
修訂日期:2017年5月(第五版)
編碼:5736-單張-中文-294-05

題號
1
2
解答
O
X

 

 


 

Understanding Renal Anemia
(認識腎性貧血)

Renal anemia is a specific symptom in patients with chronic renal failure. It is closely related to renal dysfunction.

A. The cause of renal anemia:
Patients suffering from kidney disease may have anemia at the same time, mainly due to reduction of erythropoietin (EPO), a protein produced in kidney that plays a main role in red blood cells production.

B. Other common causes of renal anemia:
1. Iron deficiency
2. Folate and vitamin deficiency
3. Malnourishment
4. Hyperparathyroidism
5. Other infection or inflammation: Common cold.
6. Blood loss through the intestine
7. Blood loss while hemodialysis
8. Shorter like span of red blood cells: Normal red blood cells can live about 120 days, while the life span of those of a patient with kidney failure will shorten.
It is the physicians who should determine which of the above causes that a patient suffers from and then give appropriate treatment. Before you take any nutrients or health food, please discuss with your physician.

C. Symptoms of renal anemia:
Fatigue, lethargy, loss of appetite, reduced exercise capacity, and out-of-breath feeling sometimes.

D. Treatment of renal anemia:
Normal hemoglobin level is 14-15g/dl, while that of a patient with chronic renal failure may reduce to less than 10g/dl Hct As a patient’s renal functions worsen, his/her hemoglobin may also reduce to as low as 7-8g/dl and below. The most common cause is the reduction of erythropoietin and thus the supplement of erythropoietin (EPO) is the most common and most effective remedy.


E. Reminders to patients taking EPO medication:
1. Medication: It should be treated by injection prescribed by your doctor.
2. Side effects: Hypertension, seizure, hyperkalemia, venous thrombosis ... and so on. Among them, hypertension is the most common adverse effect.
3. Factors that trigger poor EPO treatment may include: increased urinary toxins, iron deficiency, infection/inflammation, chronic blood loss, osteitis fibrosis, aluminum toxicity, hemoglobin disease, folic acid or vitamin B12 deficiency, multiple myeloma, malnutrition, hemolysis ... and etc.
F. Q & A:
Question 1:
Can a patient of renal anemia eat food that supplements "blood" (such as: chicken soup, pig liver) to take care of himself/herself?
Answer 1:
 The first step to treat anemia correctly is to have a physician to diagnose the symptoms and to determine the causes of anemia, and then decide how to treat the disease. Supplements of nutrients, multi-vitamin, or “blood-enhancement” products (iron) can be harmful to health. So, be very careful. It is strongly suggested that you seek the advice from your doctors before making any move in this regard.
Question 2:
When taking EPO injection for renal anemia, how can a patient look after himself/herself by eating nutrient food?
Answer 2:
Duck blood and pig blood cake are rich in iron. A patient may consult with our medical team or nutritionists on the intake amount.

編碼:5736-單張-英文-125-02
英文翻譯日期:2017年6月
依據:5736-單張-中文-294-04
中文修訂日期:2017年5月

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