Nephrology

545 PARENTAL HANDOUT FOR ANAEMIA

  • What is Anaemia?

    Anaemia is a term used to describe a lower than normal number of red blood cells and less of the oxygen carrying pigment (haemoglobin) in the blood. Red blood cells supply all parts of the body with oxygen. When there is a lowered number of red blood cells in the blood, your child may feel tired and breathless, and may not have enough energy or be able to concentrate effectively for normal schooling or playing.

    There are many causes of anaemia. The main cause of anaemia, in children with kidney failure, is a reduced production of a hormone called erythropoietin, which is normally produced by the kidneys.

    Diagnosis of Anaemia

    A simple blood test called "full blood count" (also known as FBC or FBE) which includes a haemoglobin level (also known as Hb) will show if your child is anaemic. Children with kidney failure have this test done often, to determine if treatment is required for anaemia.

    Treatment of Renal Anaemia

    As your child's kidneys make less erythropoietin than is needed, a medication called Aranesp, is prescribed. Aranesp is a protein, which is very similar to naturally occurring erythropoietin. It stimulates the bone marrow to produce more red blood cells, therefore improving anaemia and the symptoms of anaemia.

    At the present time there are 2 forms of erythropoietin products available in Australia. They are both given either as an injection into the skin or given directly into the vein.

    • Darbepoetin alfa (Aranespâ)

    Darbepoetin alfa (Aranesp) is prescribed at the Royal Children's Hospital.

    Children who are being treated with Aranesp will more than likely need to be given an iron supplement. Iron isneeded in order to make haemoglobin within the red blood cells, and Aranesp draws on iron reserves within the body. Iron storage levels are measured at the time of commencement of Aranesp treatment, and are then monitored every few months. Iron can be given by intravenous infusion over a few hours or alternatively as medicine or tablets.

    Side effects of Erythropoietin products

    Like all medications there are possible side effects. The following side effects have been reported although none of them are very common:

    • Headaches and dizziness
    • Highblood pressure
    • Mild skin rashes
    • Flu-like symptoms Bone pains and chills
    • Seizures
    • Increased appetite
    • Injection site pain
    • Muscle weakness and heart palpitations
    • Pure red cell aplasia (very rare)

    What if your child experiences any side effects?

    Any side effects your child may experience should be reported to his/her nephrologist. Sometimes they will need to be investigated as to whether the cause of the problem is related to Aranesp treatment. Changes to Aranesp treatment may sometimes be needed. Injection site pain may be helped by taking the injection out of the fridge about 20 minutes before using it, so as to allow it to warm to room temperature.  (You should never try to warm the Aranesp injection, as this could alter the chemistry of the drug).

    Pure Red Cell Aplasia (PRCA) is a condition where the body develops antibodies to erythropoietin. If PRCA is diagnosed, erythropoietin products need to be ceased. These patients need regular blood transfusions to maintain a normal red blood cell count. This complication is very rare, occurring between 1:1000 and 1:10,000 cases of individuals taking erythropoietin products. To date, no cases of PRCA have been reported in those who have only had Aranesp treatment.

    Storage and Transportation of Aranesp is very important

    Aranesp syringes should be stored in the refrigerator (between 2° and 8° C), away from light.

    Do not freeze or do not shake the Aranesp syringe.

    Aranesp is stable out of the refrigerator (not below -20°C or above 30°C) for up to 2 days.

    An Esky or "Aranesp coolie bag" will need to be used on extremely hot days to transport the syringes home from the hospital pharmacy. The hospital pharmacy department will usually provide you with an Esky to transport the syringes home if this is necessary.

    If you have any queries or questions out anything to do with your child's Aranesp treatment, please contact:
    • Renal Anaemia Co-ordinator                   ph: (03) 9345 5721
    • Nephrology Department                          ph: (03) 9345 5054