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Aluminum-Dependent Transfusions in Dialysis-Reply

James P. Crowley, MD; Joseph A. Chazan, MD
Arch Intern Med. 1988;148(10):2302. doi:10.1001/archinte.1988.00380100135034.
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In Reply.  —Aluminum toxicity has been described as a cause of hypochromic microcytic anemia in long-term hemodialysis patients. In our original report that was retrospective, we did not evaluate the aluminum status of the intensely transfused patients. However, in a prospective study of 30 intensely transfused long-term hemodialysis patients, 27 (93%) of 29 had normochromic normocytic anemia. Moreover, in the intensely transfused patients the deferoxamine-stimulated plasma aluminum concentration was 92±66 μg/L, which was similar to the mean deferoxamine-stimulated plasma aluminum concentration of 124±74 μg/L in 28 matched, nonintensely transfused hemodialysis patients. Two of the intensely transfused dialysis patients and four of the control patients were receiving deferoxamine, and it is possible that the treatment of aluminum toxicity may have improved the anemia of these patients.The patient described by Brancaccio et al did have an elevated deferoxamine-stimulated plasma aluminum level and presumably had a severe aluminum overload. The hematologic response


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