4. anemia of chronic disease

Question 1

in what type of anemia is Hepcidin elevated?

Answer 1

anemia of chronic disease

synthesized by the liver via IL-6 and IL-1β pathway

Question 2

what is the function of IL-1β and TNF-𝝰 in anemia of chronic disease?

Answer 2

they suppress bone marrow response to EPO–> reduces erythropoiesis

*IL-β directly supresses EPO production

Question 3

Etiology of anemia of chronic disease

Answer 3

inflammation: RA, SLE, IBD
infections 
malignancies: common in hematological malignancies 
aging 
chronic disorders: DM, CHF, COPD, CKD

Question 4

what iron studies can be seen in anemia of chronic disease?

Answer 4

↑ Ferritin
↓ serum Iron , TIBC, transferrin saturation

*acute infection can decrease Hb levels of 2-3g/dL within 1-2 days

Question 5

treatment of anemia of chronic disease in case treatment of the underlying cause doesn’t help?

Answer 5

transfusions (when Hgb<7-8 g/dL) and EPO analogs (epoetin- 𝝰, darbepoetin)
iron supplements

Question 6

Side effects of EPO analogs (epoetin- 𝝰, darbepoetin) ?

Answer 6

• ↑ thrombotic events
• HTN
• ↑ mortality in cancer patients