Anemia of Chronic Disease Flashcards
What are the most common conditions associated with anemia of chronic disease?
Chronic infections, autoimmune diseases (RA, lupus), malignancies, and chronic kidney disease (CKD).
What is the primary cause of anemia of chronic disease (ACD)?
Chronic inflammation leading to increased hepcidin production, which reduces iron availability for erythropoiesis.
What is the pathophysiology behind anemia of chronic disease?
Inflammation increases cytokines (IL-6), which stimulate hepcidin production, leading to decreased iron availability for erythropoiesis.
What is the expected reticulocyte count in anemia of chronic disease?
Low reticulocyte count due to impaired erythropoiesis.
What is the role of hepcidin in anemia of chronic disease?
Hepcidin prevents iron release from macrophages and inhibits intestinal iron absorption, leading to iron sequestration.
Which cytokine is most responsible for the upregulation of hepcidin in anemia of chronic disease?
Interleukin-6 (IL-6).
What laboratory findings are characteristic of anemia of chronic disease (ACD)?
↓ Serum iron, ↑ Ferritin, ↓ Transferrin saturation (TSAT), ↓ Total iron-binding capacity (TIBC).
What is transferrin saturation (TSAT), and how is it affected in anemia of chronic disease?
TSAT = (serum iron / TIBC) × 100%; it is decreased in ACD due to iron sequestration.
How can you differentiate ACD from iron deficiency anemia (IDA) using lab values?
ACD: ↓ Serum iron, ↑ Ferritin, ↓ TIBC
IDA: ↓ Serum iron, ↓ Ferritin, ↑ TIBC
What is the red blood cell morphology in anemia of chronic disease?
Typically normocytic, but can become microcytic in severe or prolonged disease.
What is the best initial test for anemia of chronic disease?
Iron studies (serum iron, ferritin, TIBC, TSAT) and complete blood count (CBC).
What is the treatment for anemia of chronic disease?
Treat the underlying chronic condition; erythropoiesis-stimulating agents (ESAs) may be used in select cases (CKD, malignancy).
How does chronic kidney disease (CKD) contribute to anemia of chronic disease?
CKD leads to decreased erythropoietin (EPO) production, which impairs red blood cell production.
What additional test should be performed in patients with anemia of chronic disease and suspected malignancy?
Age-appropriate cancer screening (colonoscopy, chest imaging, etc.) to rule out occult malignancy.
Does anemia of chronic disease respond to iron supplementation?
No, because iron is sequestered in macrophages and not available for erythropoiesis.
