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Updated: Dec 16 2021

Anemia of Chronic Disease

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https://upload.medbullets.com/topic/120230/images/differential for anemia - moises d.jpg
https://upload.medbullets.com/topic/120230/images/basophilic.jpg
  • Snapshot
    • A 56-year-old man presents to his annual physical exam with weight loss, fatigue, and weakness. He is a long-term smoker and also recently immigrated from Southeast Asia. He complains of a chronic cough for the past year with occasional bloody mucus. He agrees to undergo imaging for lung lesions and a blood test for tuberculosis. Iron studies reveal decreased serum iron, increased ferritin, and decreased TIBC. Peripheral blood smear shows basophilic stippling.
  • Introduction
    • Anemia of chronic disease resulting from decreased red blood cell production is a
      • normochromic, normocytic anemia
    • Associated conditions
      • chronic inflammatory condition
      • chronic infection
        • tuberculosis
      • longstanding malignancy
        • normocytic and normochromic anemia
  • etiology
    • Pathogenesis
      • iron is stored in macrophages or bound with ferritin
      • hepcidin is an acute-phase reactant that is increased in states of inflammation
        • inflammation causes release of hepcidin by the liver
        • ↑ hepcidin inhibits iron absorption from diet and prevents release of iron bound by ferritin from macrophages
  • Presentation
    • Symptoms of anemia
      • generalized weakness
      • fatigue
      • shortness of breath
      • headache
    • Physical exam
      • pallor
      • tachycardia
  • Evaluation
    • Labs
      • ↓ serum iron
      • ↓ TIBC, transferrin saturation
      • Normal MCV, can progress to ↓ MCV with longstanding disease
    • Peripheral blood smears
      • normochromic RBCs
      • may be normocytic or microcytic
      • basophilic stippling
        • can be seen in alcohol abuse, lead poisoning, thalassemias, and hereditary pyrimidine 5'-nucleotidase deficiency
  • Differential Diagnosis
    • Anemia of renal disease
    • Iron deficiency anemia
    • Aplastic anemia
  • Treatment
    • Treat underlying disease
    • If underlying disease is unknown or treatment of underlying disease does not improve symptomatic anemia
      • measure EPO
        • if low, administer EPO or erythropoiesis-stimulating agents (ESAs)
          • make sure iron stores are sufficient
          • if insufficient, patients may be resistant to EPO
  • Complications
    • Severe anemia
  • Prognosis
    • Varied based on underlying inflammatory condition
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