Henry is 77 years old and lives with his daughter and son-in-law. He has chronic renal failure, but ...

Henry has anemia of deficient red blood cell production as a result of his chronic renal failure (or chronic disease anemia). The chronic renal failure causes a reduction in erythropoietin production. Furthermore, increased serum levels of nitrogen and uremic toxins interfere with erythropoietin activity and red blood cell survival. On a smear, the red blood cells would appear normocytic and normochromic.

Chronic disease anemia involves a decrease in circulating erythrocytes and oxygen-carrying capacity of the blood. As a result, tissue hypoxia ensues and creates the symptoms of weakness, fatigue, and dyspnea. Central nervous system hypoxia leads to headaches and dizziness. In the elderly individual, cognitive impairment and depression are also indications of hypoxic change in the central nervous system.

There is an increased production of 2,3-DPG by erythrocytes in an attempt to lower hemoglobin affinity with oxygen. The result is that oxygen is more readily released by red blood cells at areas where it is needed most. This is evidenced by a shift to the right on the oxygen-hemoglobin dissociation curve.