Anaemia - Anaemia of Chronic Disease (Normocytic)

Question 1

Definition

Answer 1

Anaemia which is secondary to chronic disease
Second most common anaemia
Commonest anaemia in hospital patients
Occurs in individuals with chronic infections
- TB
- Crohn’s
- Rheumatoid arthritis
- SLE
- Malignant disease

Question 2

Risk factors

Answer 2

Autoimmune disorders
Malignancy
Acute/Chronic infection
Critical illness/major trauma or surgery with delayed recovery
Chronic disease

Question 3

Pathophysiology

Answer 3

• RBC = normocytic but they can be microcytic = rheumatoid arthritis + Crohn’s disease
• Decreased release of iron from bone marrow to developing erythroblasts
• Decreased RBC survival = direct circular destruction via toxins from cancer cells, virus, bacteria
• Decreased RBC production = cytokines (such as IL-6) lead to elevated levels of hepcidin in the liver (which regulates iron metabolism) = causes Fe2+ to move into macrophages so decreased absorption of Fe2+ in the GI tract = also impairs bone marrow response to erythropoietin.

Question 4

Signs and symptoms

Answer 4

Fatigue
Headaches
Syncope
Dyspnoea
Breathlessness
Anorexia
Intermittent claudication
Palpitations

Question 5

Diagnosis

Answer 5

Peripheral blood smear = Normocytic normochromic
(Or microcytic hypochromic in RA + Crohn’s)
Raised serum ferritin = due to inflammation
- helps distinguish from IDA
Serum iron + transferrin = low

Question 6

Treatment

Answer 6

Treat underlying cause
Supplementation iron (ferrous sulphate)
Blood transfusion (risk of volume overload)
Erythropoietin stimulating agents (ESAs) - EPOEITIN ALFA

Question 7

Side effects of EPOETIN ALFA

Answer 7

Flu-like
HTN
Mild rise in platelet count
Thromboembolism