Normochromic Normocytic Anemia

  • Normochromic = Normal color
  • Normocytic = Normal cell

The anemia in this case is that the RBC’s are normal looking but there is not enough of them. NN Anemia is associated with chronic disease states such as renal disease, cancer and HIV.  All these individuals are prone to normochronic normocytic anemia.

Kidney disease: If a person has very severe kidney damage and the kidney’s are not functioning, then this patient will be on dialysis. In addition to the kidneys not filtering the urine, the kidneys are also not producing the hormone known as erythropoietin. Erythropoietin is a hormone that stimulates their blood marrow to produce RBC. Their bone marrow is healthy but the hormone isn’t present to stimulate it to produce RBC. Historically, these people needed blood infusions.  But over 20 years ago, Amgen spliced a gene into a bacteria, to make it produce erythropoietin. They harvested the erythropoietin and put it as an injectable drug.  Every dialysis patient got these erythropoietin injections.

Cancer and HIV: Then they realized that this could be useful for other disease states.  Cancer and HIV/AIDS patients were receiving erythropoietin.  However, a study came out around 2008 that hurt Amgen. What they found was that giving the cancer patients erythropoietin to get their hemoglobin and hematocrit count up was not good for these patients.  It was providing more oxygenation for their body but it was also providing oxygenation for the cancer cells.  These patients were actually dying of the cancer faster!  The use of the drug dropped dramatically.  Insurance and medicare stopped paying for it unless it was very clearly needed.  As a result a new guideline came out that this drug should not be used with cancer patients unless they have very severe NN anemia.

Something that doesn’t exist yet, but will are generic genetically engineered drugs. The genetically engineered drugs have 13 year long patents. We aren’t sure how the FDA will deal with this to monitor the proper availability among all manufacturers.

Recap

  • Associated with chronic disease states
    • Renal Disease, Cancer, HIV
  • Erythropoietin
    • Hormone produced in the kidney to stimulate RBC production in bone marrow
    • Synthetic genetically engineered hormone is commercially available
    • Helps avoid the need for transfusions
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