Q: Can iron, folic acid and salmon omega be given to a patient who is anaemic and has shrunken kidneys? The patient also undergoes dialysis at times.

A:Patients with chronic renal disease develop anaemia (normochromic normocytic) due to reduced synthesis of a hormone called erythropoietin (EPO), which is secreted by the kidney. Erythropoietin stimulates the marrow to produce red cells. Reduced survival of red cells due to increased ‘toxins’ in the blood also contributes to anaemia while haemodialysis can worsen the anaemia due to the procedure-associated blood losses. Sometimes patients with chronic dialysis may develop hypersplenism, further destroying RBCs. The standard treatment is by EPO injections. Generally, one tends to avoid transfusions to prevent inhibition of the low, although present, positive feedback on EPO secretion exerted by chronic hypoxemia. Before therapy is initiated, other possible deficiencies like vitamin B12, folate or aluminium intoxication are ruled out. Throughout the course of therapy, iron stores (serum iron, ferritin and TIBC) should be determined frequently, since the rapid proliferative response may not be accompanied if iron stores are inadequate and iron replacement should be given. Yes, the patient can be given vitamin B12 and folic acid. There is no role of omega fatty acid in the treatment of anaemia.