Anaemia of Chronic Disease - Microcytic Anaemia

Question 1

What is the Pathophysiology behind ACD?

Answer 1

• Hepcidin Mediated
• Erythropoiesis inhibited
• Low EPO levels
• Increase Phagocytosis of erythroid cells

Question 2

What is the mechanism behind hepcidin mediated ACD ?

Answer 2

• Chronic inflammation causes an increased in IL-6 leading to an increase in Hepcidin. Hepcidin ( blocks Ferroportin (exports iron out of the cells)) of iron absorption from the intestines and macrophage iron recycling
• It also causes increase iron uptake into cells but stops iron being released from the cells
• This leads to a decrease in iron availability

Question 3

What are the Clinical Features of ACD?

Answer 3

• Fatigue
• Headache
• Dizziness
• Palpations
• Angina
• Dyspnoea

Question 4

What investigations should be done for ACD?

Answer 4

• FBC
• CRP
• Haematinics
• Iron Studies
• Blood Film

Question 5

What essential bloods are needed in ACD?

Answer 5

• Serum Ferritin ( Normal/ Raised as an Acute Phase Reactant - stored iron)
• Serum Iron (tends to be low)
• Total Iron Binding Capacity (tend to be low)

Question 6

What are the iron stores like in ACD?

Answer 6

• Iron stores are normal/ increased

Question 7

What is the management for ACD?

Answer 7

• Treating the underlying disorder
• Correcting Iron, B12 and Folate Deficiency
• EPO, Parenteral iron, Transfusions

Question 8

What does it mean if you TIBC is low?

Answer 8

• If you have a low TIBC this means that you have high iron stores as iron is being carried around the body.

Question 9

What does it mean if your TIBC is high ?

Answer 9

• This means the binding capacity of transferrin is higher and therefore less iron is bound to it.
• This is highly indicative of iron- deficiency anaemia