Anaemia of chronic disease

Question 1

Definition

Answer 1

Normochronic, normocytic anaemia associated with chronic inflammatory disorders (PMR, Pressure sores, skin ulceration), renal impairment, chornic infections and malignancy

Question 2

Pathophysiology

Answer 2

Due to reduced release of iron from bone marrow despite complete iron stores and poor erythropoetin response to anaemia, causing reduced erythropoesis and shortened red cell survival

Question 3

How to differentiate ACD from IDA

Answer 3

Check ferritin (reduced in IDA, elevated in ACD

Question 4

Investigations

Answer 4

• Peripheral blood film
• reticulocyte count (indicated haemolysis: high LDH, high bilirubin, high haptoglobins, positive direct coombes test suggests haemolytic anaemia)
• B12, Folate (MCV can be normal in these deficencies
• Urea and electroyltes
• albumin
• LFTs
• ESR
• CXR

Question 5

Management

Answer 5

• Treat the underlying cause
• if symptomatic anaemia, consider blood transfusions and Erythopoetin-stimulating agents