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CBC, Serum Proteins, and Immunoglobulins in Chronic Hemodialysis Patients with or without Pruritus in Egypt

Nabaa Kamal Al shafei and Abdelfattah Nour

Several blood parameters and serum biochemical values have been associated with pruritus in hemodialysis (HD) patients. However, the pathogenesis of uremic pruritus (UP) is still obscure. It is of interest to find some blood values that can predict the progression of pruritus from mild to severe in HD patients. The occurrence of pruritus, its duration, severity and correlation with patient’s laboratory data was evaluated. Blood samples from hemodialysis patients and hemodialysis patients with mild, moderate, and severe pruritus were taken during the dialysis. In addition, blood samples from non-renal failure normal control. The association between severity of pruritus and blood and serum laboratory parameter including, RBCs, HCT%, Hb, total and differentiation WBC counts were evaluated. In addition, the relationships of total protein, albumin, globulin, IgA. IgM, IgG, and IgE with severity of pruritus were examined. In general CBC values slightly decreased in the pruritus patients when compared with control group, however, the differences were not statistically significant (P > 0.05). The Hb and HCT% were not different. However, there was a neutropenia observed in patients with pruritus as compared to the control. Similarly, compared to the HD control, lymphocytes and monocytes slightly decreased in pruritius patients, while basophils slightly increased. However, these differences were not statistically significant. There was a significant increase in eosinophils absolute numbers in the pruritus groups when compared with that of the HD control group. On the other hand, serum total protein, albumin and globulin concentration in normal control and hemodialysis patients with and without pruritus were not statistically different. Our study demonstrated that there was a highly significant decrease in serum level of IgA, IgG, and IgM levels in pruritus patients compared to that of the control groups. IgA level decreased in pruiritus patients compared to the HD control. Except for mild pruritus patients, IgM and IgG increased in pruritus patients compared to the HD control with no pruritus. On the other hand, IgE showed significant increase as the pruritus becomes severer. The highest IgE value was observed in the severe pruritus compared with the non-pruritus control and the mild and moderate pruritus groups. Increased IgE may have led to eosinophilia in hemodialysis patients with pruritus. It seems that there is possible link between the dialyzing membrane, pruritus, eosinophilia, and IgE, and this link necessitates future studies.