Anaemia - Anaemia of Chronic Disease Flashcards
Outline the epidemiology of anaemia of chronic disease.
None
Because ACD is a consequence of immune system activation attributable to many causes, epidemiological data specific to this entity are not available.
What are the risk factors of anaemia of chronic disease (6)?
Hx of:
* Autoimmune disorders
* Malignancy
* Acute or chronic infection
* Critical illness, major trauma, or major
* Surgery with delayed recovery
* Chronic disease
Outline the pathogenesis of anaemia of chronic disease (3).
- ACD is principally caused by inflammation
- Various processes trigger release of pro-inflammatory cytokines
- Systemic changes in iron metabolism, regulated by the inflammatory cytokine cascade and hepcidin (an iron-regulatory peptide hormone produced by the liver), decrease red blood cell (RBC) production and reduce RBC survival
Outline the pathophysiology of anaemia of chronic disease (4).
- In ACD, serum iron levels fall (as a result of elevated hepcidin), retarding erythropoiesis and causing anaemia
- Red blood cells (RBCs) that are produced in this low serum iron milieu are individually microcytic and hypochromic
- Erythropoiesis is additionally impaired when infection involves the marrow (as in HIV, hepatitis C, and malaria) or tumour cells infiltrate the marrow
- Finally, survival of circulating RBCs (especially those near the end of their lifespan) may be shortened by increased erythrophagocytosis by macrophages and damage by cytokine-generated free radicals
How would a patient with anaemia of chronic disease present (5)?
Common:
* Decreased exercise tolerance
* Shortness of breath with exercise
* Fatigue
* Pallor
* Hx of risk factors (Systemic symptoms of underlying condition)
* Absent history of bleeding
* Physical finding suggesting infection
* Physical finding suggesting neoplasm
* Physical finding suggesting autoimmune disorder
Diagnosis of exlusion:
* Absent history of high alcohol intake
* Absent history of exposure to chemicals and radiation
* Absent history of drugs known to be associated with risk of anaemia
* Absent history of poor nutrition
What investigations are recommended in suspected anaemia of chronic disease (8)?
- FBC
- Peripheral blood smear
- Serum ferritin
- Serum iron
- Total iron binding capacity
- Transferrin saturation
- Absolute reticulocyte count
- Serum creatinine
What would is the diagnostic result of FBC in anaemia of chronic disease?
- Hb
- MCHC
- MCV
- Platelet
- WBC count
- Hb: reduced or normal
- MCHC: reduced or normal
- MCV: reduced or normal
- Platelet may be elevated
- WBC count: may be elevated
What would is the diagnostic result of peripheral blood smear in anaemia of chronic disease?
RBCs can be microcytic, hypochromic
What would is the diagnostic result of serum ferritin in anaemia of chronic disease?
Increased
What would is the diagnostic result of serum iron in anaemia of chronic disease?
Reduced
What would is the diagnostic result of total iron binding capacity in anaemia of chronic disease?
Normal or reduced
What would is the diagnostic result of transferrin saturation in anaemia of chronic disease?
Reduced
What would is the diagnostic result of absolute reticulocyte count in anaemia of chronic disease?
Low
What would is the diagnostic result of serum creatinine in anaemia of chronic disease?
Variable
What is the management of a patient with anaemia of chronic disease persistent with mild to moderate anaemia (1)?
Treatment of underlying disease and observation
