Microcytic anemia, a disease characterized by the presence of small red blood cells in blood, has been described in renal patients. This disease occurs in the absence of iron deficiency and is reversed following the use of purified dialyzate. The mechanism by which aluminum induces microcytic anemia is uncertain, but it has been suggested that a disturbance in the hem biosynthetic pathway may be involved. In this context, the red blood cells of intoxicated dialysis patients may contain a considerable fraction of the total blood aluminum content.
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