First and foremost, I welcome you to my new look blog. It has undergone background tweaks and fixes which I am proud of. This blog has evolved as I have been looking for my voice as a writer. I finally settled on three categories under which we shall be fit together. Healthy Living, Nursing Matters and Miscellaneous topics are the rooms under which my posts will be housed. With this new outlook, you can easily contact me and subscribe to an email alert to keep abreast with new posts every Wednesday.

Now that that is safely out of the way, let us dip our fingers into the jar of Healthy Living today. My aim is to demystify medical language. That has not changed ha ha. This helps you to understand concepts in a language common to the general population.

Anemia is simply low red blood cell count in the Blood. The blood is comprised of water and other solutes. These solutes are called cells. We may be familiar with some of them like white blood cells which are responsible for fighting infections, platelets which help with clotting of the blood and then we have red blood cells which help in carrying oxygen to all parts of the body.

Red blood cells are made in the bone marrow. They then circulate in the blood for about 120 days before dying away and being replaced by new ones. It is an ongoing process. When they die, they are converted into products which the body can eliminate either though the gut or the kidneys in form of urine.

For red blood cells to be made, a person needs to have a few things in their body. Some include Iron, Folic acid and Vitamin B12. More than anything else, Iron must be present in sufficient stores for red blood cells to be produced. In the bone marrow however, the production of red blood cells cannot occur unless we have a special hormone called Erythropoietin. Because you are amazing, you will allow me to abbreviate that very long word into three letters: EPO.

EPO is the engine without which production of red blood cells cannot happen. It whispers in a soothing voice to the ever-willing damsel that is the bone marrow that it is time to act. The bone marrow opens one sleepy eye, checks to see whether she has enough Iron and if she does, she offers a tantalizing smile to EPO, gives a confident thumbs up and springs into action. She starts churning out thousands upon thousands of small, biconcave-shaped beauties that we call the red blood cells.

This brings me to chronic kidney disease especially stage 5 of kidney disease where we usually start the patient on dialysis. What goes wrong?

For the sake of posterity, it is necessary to repeat that in stage 5 of kidney failure, the kidneys are unable to do their work. Part of that work is to remove waste products from the body in form of urine. The other function is to produce this hormone we are calling EPO.

Therefore, we can safely say that lack of EPO in kidney failure is one of the reasons why someone may develop anemia. The other reason is that because the body has too much waste products, they cause the red blood cells to die before their time. These waste products also prevent Iron from being absorbed in the intestines from the food we eat. All these factors join hands to form an evil wall that gives the person anemia.

When they start hemodialysis, patients lose some amount of blood with every session in the blood tubes that are used. If not that, the use of needles and central venous catheters leads to some blood loss too. In someone who has no other issues to deal with, this may not be significant at all. However, we have already established the various ways in which things have gone awry in the production of red blood cells for someone with chronic kidney disease. We therefore are making a bad situation worse by the very act of saving life through hemodialysis. Collateral damage.

This is why patients on dialysis regularly get EPO and Iron injections. With anemia, the heart gets tired easily and this leads to heart failure in the long run. That is why we want to ensure that the blood has adequate red blood cells by correcting anemia of chronic kidney disease.

As always, this has been a pleasure.