The anaemia of chronic kidney disease is associated with cardiovascular disease, decreased quality of life, and mortality. The introduction of recombinant human erythropoietin (rHuEPO) has transformed the management of this condition. However, a significant proportion of patients fail to respond to even high doses of rHuEPO. We report a patient, known to have thalessemia trait, with Chronic Kidney Disease Stage 5, secondary to hypertensive nephrosclerosis, on conservative therapy, who had progressively increasing EPO requirement. Anaemia persisted despite IV iron supplementation and large EPO doses. Persistent anaemia was initially attributed to the thalassemia trait and recurrent bleeding per rectum, which were actually red herrings. Further evaluation including a bone marrow aspirate, led us to the diagnosis of myeloma (light chain disease). The only clue to the diagnosis of myeloma in this patient was refractory anaemia and erythropoietin hyporesponsiveness.
Dhanya Mohan, Mohammed Railey, Fakhriya Alalawi and Amna Khalifa Alhadari