Hyperparathyroid bone disease.

Abstract

A 52-year-old haemodialysis patient developed normochromic normocytic anaemia requiring weekly blood transfusions. He was resistant to high-dose epoetin alfa and intravenous iron therapy. A blood film examination revealed tear-drop poikilocytes. Serum B12, red cell folate, iron studies, serum protein electrophoresis, serum-free light-chain assay and haemolysis screen were all normal. The corrected serum calcium level was 2.43 mmol/L (2.15–2.55), phosphate 1.58 mmol/L (0.81–1.45) and PTH 225 pmol/L (1.0–7.0), consistent with tertiary hyperparathyroidism attributable to end-stage renal disease.