undiagnosable infection

[misc1234us]

Hi,
My dad is on dialysis for the past 6 years. During the past 5-6 months, his hemoglobin count started to drop to as low as 5.5. His nephrologist said he has an infection in his lungs and tried treating him with meds for tuberculosis (all tests for tuberculosis came back negative though).  The doctors did ECGs and declared his heart was functioning as before (as it did 6 months ago) -

The infections specialist was called in finally and she was able to treat his infection but only temporarily - his 103 fever has returned and the doctors are at a loss as to the real diagnosis. My hunch is that the low hemoglobin and the infection are related but dont know if this could be verified - can you please suggest any ideas that our doctor could explore?

The doctor said my dad probably has very low immunity - is there a way one can measure "low immunity"?

When his fever was 103 on 7/15, the following reports showed up:
The doctor started him on an antibiotic but i was reading online and a viral infection of the bone-marrow could cause a low hemoglobin count too - is there a way to identify why the hemoglobin count is so low? his hemoglobin was a healthy 11 for a long time until 6 months ago :(

so two major complaints - low hemoglobin+hemocrit, and recurring 103 fevers (impacting his blood pressure at times(low 90/50 BP))

CBC 7/15
Hemoglobin  8.8  (after transfusing 2 units the prev day)
Haematocrit  27.5  
RBC COUNT  3.2  
MCV  86  
MCH  27.6  
MCHC  32  
RDW  12.5  
TLC Count  10.7  
Platelet Count  260  
Neutrophils  65  
Lymphocytes  25  
Eosinophils  02  
Monocytes  08  
Basophils  00  
RBC:  Normocytic with polychromasia +    
WBC:  Total and Differential counts are within normal limits    
Platelets:  Adequate on the smear  

C-REACTIVE PROTEIN (CRP)  199  

VITAMIN B12 - SERUM  1467
VITAMIN FOLATE - SERUM  17.1  

Thanks in advance for any ideas - and please let me know if you need any additional data ,
Santosh

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
With fever and anemia, kidney should be reassessed for infection. Kidney infection cause anemia. A urine examination should be done and if RBC are detected in them, then complete kidney function panel should be done. Leukemias, liver infections, parasitic infects of gut like amebiasis and giardiasis and SLE can all cause anemia and fever.
Do discuss this with your doctor and get your father examined in this line.
Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!

[beanie485]

have they checked for MRSA?

[Admirer]

Your dad might be facing the  complications of hemodialysis.
Common complications associated with the procedure include dehydration and electrolyte imbalance. These might lead to heart problems such as angina, hypotension, and arrhythmia if unchecked or left untreated. Infection of the abdominal wall which leads to inflammation of tissue might also occur. One might also develop weakening of the arterial muscles. It is possible to get meningitis as a result of a bacterial infection.
Hemolysis may result from a number of biochemical and toxic insults during the dialysis procedure. The half-life of red blood cells in renal failure patients is approximately one half to one third of normal and the cells are particularly susceptible to membrane injury.
Hemoglobin levels below 10 g/dL lead to left ventricular (LV) hypertrophy, LV dilation, a lower quality of life, higher cardiac morbidity, and a higher mortality rate in end-stage renal disease.
Partial correction of the anemia of renal failure, with epoetin , improves quality of life, exercise capacity, cognitive function and ameliorates LV hypertrophy.
Haemodialysis impairs the function of neutrophil leukocytes, which are the main cells of the specific defence system during bacterial infections. Iron overload, high intracellular calcium and uraemic toxins are considered the main cause of neutrophil dysfunction.