dialysis/blood loss

[AngelofSeduction]

hi i just wanted to know do people lose blood during dialysis. i thought your own blood is being filtered and returning back to you. im trying to write a care plan for my patient who came in with GI bleeding but is end stage renal failure and her hemoglobin is very low around 6. she is also diabetic. when i was assessing her she complained of pain on her heels laterally and her skin was cool.since i just learned about peripheral artery disease i was going to use decreased tissue perfusion r/t anemia secondary to end stage renal failure . i dont know if thats good enough.she had so much going on and her nails are very dark,i can barely feel her pulses and when i tried listening to her heart sounds i could barely hear the lub dub. i heard a few gurgling. i told her when she is laying down try to do some movements with her feet and dangle her feet to get some blood circulated.also what is the correlation between end stage renal failure,anemia and GI bleeding.im reading that renal failure can cause GI bleeding but i dont understand how. i understand how the kidneys can contribute to anemia because they are not producing erythropoeitin..i just learned about the different types of anemias just trying to put the pieces together

[talaxandra]

1. There is some blood loss in haemodialysis, for two reasons. The first is that not all cells are able to be returned to the patient; the second is that the act of HD causes a per centage of RBCs to rupture.

2. In addition to PVD you may want to look at peripheral neuropathy as a contributing factor to the heel pain.

3. People with end-stage renal failure are anemic for four reasons: blood loss if they're on HD (higher for interval dialysis, lower for home therapy); reduced erythropoietin production and thus fewer RBC's to start with; dietary restrictions that result in vitamin and mineral deficiencies; and a reduction in the life span of RBCs because of altered blood biochemistry. Iron and erythropoietin supplements are commonly prescribed but are not as effective as normal function, and the latter can cause iron-deficiency anemia.

4. There are many risk factors for GI bleeding in ESRF, including the vascular malformations that can result from long-term erythropoietin-resistant anemia. You may find this paper helpful: http://www.nature.com/ki/journal/v64/n4/full/4494040a.html