Q: I am a 17-year-old boy, weighing 52 kg. I had chronic renal failure and underwent a surgery. I had severe kidney anaemia for quite some time, probably just under less than one year. My haemoglobin level was 6. Is it likely that due to this, my memory was impaired or that there was decreased learning ability in addition to fatigue and lack of concentration?

A:Formation of blood cells (haematopoiesis) depends on several factors like the presence of stem cells in the bone marrow that are capable of differentiating and developing into mature blood cells; a supportive bone marrow environment for stem cell survival and functioning, and the presence of growth factors that control the division, differentiation, and survival of blood cells. Any irregularity results in anaemia. The red cells arise in the bone marrow under the influence of a hormone called erythropoietin (EPO) produced by the kidneys and thus, any chronic kidney disease resulting in less EPO production, leads to anaemia. The development of anaemia in kidney disease is usually gradual (chronic anaemia) mirroring the declining kidney function. The body tends to adapt to the developing anaemia over time and due to this, the symptoms of anaemia may not be as noticeable compared to a patient who develops it suddenly (acute anaemia). Being the oxygen transport protein of the body, a fall in haemoglobin affects the rate of delivery of oxygen to the tissues. As anaemia develops, this oxygen delivery falls and the heart has to work harder in order to pump blood more rapidly to the tissues so that oxygen demands can still be met. This extra work by the heart thickens the muscle leading to a condition called left ventricular hypertrophy (LVH). The symptoms of anaemia depend upon its severity, the severity of the kidney disease and the presence or absence of other illnesses. Commonly, a patient may report fatigue and an inability to carry out physical activities (initially heavy exertion but progressing to normal daily activities). There may be progressive shortness of breath, difficulty in concentrating & memory and an inability to perform mental tasks. Anaemia may also affect libido and worsen existing heart disease. Treatment of anaemia is by administration of EPO, iron and, sometimes, vitamin B12 & folic acid. The aim is to keep the haematocrit around 33 to 36% and haemoglobin 11 to 12 g/dl. You will feel definite symptomatic improvement as your haemoglobin improves.