Review Question - QID 102784

This patient is suffering from anemia of chronic disease. A blood transfusion with packed red blood cells is the best therapy for this patient.

Anemia of chronic disease, also known as anemia of chronic inflammation, is characterized by decreased RBC production due to impaired iron utilization. In inflammatory states, the liver produces increased amounts of hepcidin, which prevents release of iron stores. The patient cannot effectively manufacture RBCs, and presents with (1) decreased serum iron, (2) low TIBC with low-to-normal transferrin saturation, and (3) increased ferritin. The presence of normal amounts of stored iron confirms the diagnosis.

Spivak reviews the characteristics of anemia of chronic disease. Anemia of chronic disease is a hypoproliferative disorder with no known cause but typically is associated with disorders such as inflammation, infections, or neoplasms. The anemia typically resolves when the disorder resolves.

Weiss and Goodnough discuss the treatment for anemia of chronic disease. Treatment aims to target the underlying disease as this will typically resolve the anemia. But if the anemia is severe a blood transfusion can be helpful. For patients who are undergoing chemotherapy, who have chronic renal disease, or who have AIDS, they can benefit from erthyropoietic agents.

Incorrect answers
Answer 1: Erythropoietin injections are appropriate in anemia of chronic disease if the patient has low EPO. This patient's EPO is normal, making her unlikely to respond to EPO therapy.
Answer 2: Intrinsic factor allows the absorption of Vitamin B12 in the terminal ileum. Intrinsic factor is produced by the parietal cells of the stomach and is absent in pernicious anemia. This patient does not have pernicious anemia nor a Vitamin B12 deficiency and does not need intrinsic factor.
Answer 4: Leucovorin, also known as folinic acid, is given concomitantly during treatment with methotrexate to prevent folic acid deficiency. This patient is not taking an antifolate drug nor does she have a folic acid deficiency.
Answer 5: Ferrous sulfate is used to treat iron deficiency anemia. This patient has anemia of chronic disease, not iron deficiency anemia. Iron deficiency anemia is characterized by decreased serum iron, decreased ferritin, increased TIBC, and decreased % saturation.