1.3 Anaemia of Chronic Disease

Question 1

Anaemia of Chronic disease
0 Anaemia found in unwell patients with no obvious causes of anaemia e.g. bleeding, iron, folate or B12 deficiency, haemolysis (also called anaemia of chronic inflammation)
o Epidemiology – 2nd most common cause of anaemia after ____________________
- Associated conditions –
o Chronic infections e.g. tuberculosis, osteomyelitis, septic arthritis or endocarditis
o Chronic inflammation e.g. rheumatoid arthritis, IBD, SLE and other rheumatological conditions
o Malignancies
o Others e.g. cardiac failure, acute variants (e.g. severe sepsis, myocardial infarct)

Answer 1

iron deficiency anaemia;

Question 2

Pathogenesis
- __________ is the central protein controlling iron metabolism (especially in ACD)
o In ACD, presence of cytokines, especially _______ (and others such as IL-1, TNF α, IFN γ and β) leads to decreased marrow responsiveness (and erythroid precursors) to ________, increased __________________, and decreased EPO synthesis by renal cells
o Inhibitory effect of EPO on hepcidin release is lost – increased hepcidin leads to shutdown of mobilisation of iron from external sources (absorption in duodenum) and internal source

Answer 2

Hepcidin;

IL-6 ;

EPO;

apoptotic death and phagocytosis of precursor cells

Question 3

Laboratory features of ACD
- Mild anaemia (usually ____________), about 20% have more severe anaemia (< 8 g/dL)
- Usually ____________ anaemia, about 20% microcytic, hypochromic (MCV usually >70 fL)
- Inappropriately low _________________ – decreased responsiveness of marrow and erythroid precursors to EPO and decreased EPO production by renal cells
- Iron studies
o High ferritin – ferretin is an acute phase reactant (APR), increasing in response to inflamation
o Low transferrin – transferrin is a _____________, lowered _________________, which is reflective of transferrin
o Low serum iron – as most serum iron is bound to transferrin
o Low or normal iron saturation of transferrin
- Ferritin is an ARP – cut-off value for diagnosis of iron deficiency is usually _____ for normal individuals (reference range is 20 to 300 g/L)
o In inflammation, iron deficiency can be confidently diagnosed when ferritin levels are higher (e.g. when less than ________)

There is no single diagnostic criteria for ACD – other supportive findings include
o Clinical presence of a source of inflammation with or without fever
o High inflammatory markers e.g. ESR, CRP, ferritin
o Together with exclusion of other treatable and common causes of anaemia

Answer 3

10 to 11 g/dL;

normocytic, normochromic;

reticulocyte count;

negative APR;

total iron binding capacity (TIBC);

<20 g/L;

60 g/L

Question 4

Differential diagnosis of ACD

• Concurrent iron deficiency
• Concurrent anaemia due to kidney disease e.g. ____________
• Concurrent endocrine disorders e.g. ___________ (can be treated with thyroxin supplementation etc.)

Answer 4

renal anaemia;

hypothyroidism