To the Editor.
—We read with interest the article by Crowley and coworkers1 describing the results of a retrospective study on the transfusion practice of a large renal hemodialysis center. We believe that the nephrologist's major concern is the more intensely transfused patients who, although a minority, require the majority of transfusions (67%, in that study).1We all look forward to the introduction in clinical practice of recombinant human erythropoietin, which will help our patients' bone marrow performance, but we must not forget that erythropoietin deficiency is not the only cause of anemia in hemodialysis patients, especialy intensely transfused ones. Crowley et al1 do not mention a widely accepted cause of dialysis anemia: aluminum intoxication.2,3 Assuming good control of aluminum levels in the dialysate, aluminum intoxication may occur in patients taking aluminum-containing gels to control hyperphosphatemia.4 The anemia caused by aluminum poisoning is non— iron-deficient,
Brancaccio D, Gallieni M, Anelli A, Padovese P. Aluminum-Dependent Transfusions in Dialysis. Arch Intern Med. 1988;148(10):2299-2302. doi:10.1001/archinte.1988.00380100135033