Polycythemia in a Pediatric Patient with Chronic Kidney Disease: Overuse of Erythropoetin During COVID-19 Isolation

Kandur, Yaşar Alpcan Ayşegül Yozgat Mehmet Tursun Serkan

We describe a case of a patient with Chronic Kidney Disease who developed polycythemia due to Erythropoiesis Stimulating Agents overuse during COVID-19 isolation. A 12-year-old male had not been able to attend routine controls since had been in isolation for 4 months after the COVID-19 outbreak. He had continued to take Erythropoiesis- Stimulating Agents during that period at the starting dose of 150 U/kg/week. He had been on peritoneal dialysis in the last year because of end-stage renal failure. Laboratory investigation revealed a hemoglobin (Hb) level of 20.8 g/dl, hematocrit level of 66%, creatinine level of 6.5 mgr/dl. He underwent daily phlebotomy sessions (10cc/kg/session). During this period aspirin was also started (5mg/kg). After 5 sessions his Hb level decreased to 14 gr/dl and hematocrit to 40%. Pediatric nephrologist should be aware that there is a potential risk of polycythemia with Erythropoiesis Stimulating Agents when Hb level is not appropriately followed on a routine basis. (English) [ABSTRACT FROM AUTHOR] COVÍD-19 izolasyonu sırasında Eritrosit Stimule Ajanın (ESA) aşırı kullanımına bağlı gelişen polisitemi vakası sunmayı amaçladık. On iki yaşında ki kronik böbrek yetmezliği tanılı erkek hastamız, COVÍD-19 pandemisinden dolayı 4 ay boyunca tecritte kaldığı için rutin kontrollerine gelememişti. Bu süre zarfında haftada 100 U/kg idame dozunda ESA almaya devam etti. Hasta periton diyaliz tedavisi altındaydı. Laboratuvar incelemelerinde hemoglobin (Hb) seviyesi 20.8 g/dl, hematokrit % 66, kreatinin 6.5 mgr/dl bulundu. Hastaya günlük flebotomi seansları (10cc/kg/seans) uygulandı. Bu dönemde aspirin tedavisi de başlandı (5 mg/kg). Beş seans sonunda Hb seviyesi 14 gr/dl'ye, hematokriti % 40'a düştü. Kronik Böbrek yetmezliği hastalarında hemoglobin düzeyi rutin şekilde takip edilmediği takdirde ESA' ya bağlı polisitemi gelişebileceği başta aile hekimi olmak üzere tüm hekimler tarafından bilinmeli ve izolasyonda olsa dahi hastalar gerekirse ev ziyarteleri ile takip edilmeli. (Turkish) [ABSTRACT FROM AUTHOR] Copyright of Journal of Pediatric Disease / Cocuk Hastaliklari Dergisi is the property of Turkish Journal of Pediatric Disease and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)