Anemia of chronic disease

While iron deficiency remains the most common cause of anemia worldwide, low iron stores are associated with symptoms regardless of the presence of typical microcytic, hypochromic anemia and may be hard to recognize in patients with concurrent inflammation. Diagnosing and treating iron deficiency become more of a challenge because markers of iron status are influenced by low-grade inflammation present in common conditions, such as chronic kidney disease, cirrhosis, or heart failure. Here I present a pragmatic way of interpreting diagnostic lab tests to help clinicians recognize patients who are most likely to benefit from iron supplementation, choose between oral and parenteral administration, and make personalized decisions when patients do not fit usual guidelines. Learning Objectives • Recognize chronic inflammatory conditions that affect the interpretation of laboratory markers of iron status • Identify patients most likely to benefit from iron supplementation using ferritin and transferrin saturation • Understand risks and benefits of oral and IV iron preparations Clinical case A 56-year-old woman was referred for evaluation of anemia. She had a medical history of rheumatoid arthritis treated with methotrexate, hypertension treated with lisinopril, type 2 diabetes mellitus treated with pioglitazone, nonalcoholic fatty liver disease, and stage 3 chronic kidney disease with an estimated creatinine clearance of 32 mL/min per 1.73 m 2. She reported progressive fatigue, dy...

Normocytic anemia happens when you have fewer red blood cells than normal, and those blood cells don’t have the normal amount of hemoglobin. Most people develop normocytic anemia because they have an underlying chronic illness. Healthcare providers treat normocytic anemia by treating the underlying illness. Overview What is normocytic anemia? Normocytic anemia happens when you have fewer Healthcare providers may refer to normocytic anemia as a medical condition or as a sign of other conditions. Sometimes, people have normocytic anemia because they have an inherited condition. Most of the time, people develop normocytic anemia because they have an underlying chronic illness. Healthcare providers treat normocytic anemia by treating the underlying condition. Symptoms and Causes What causes normocytic anemia? Three main things cause normocytic anemia. You may develop normocytic anemia if: • You’re losing blood. There are many reasons why you may lose blood, such as being injured or having a medical condition that causes internal bleeding. You can develop normocytic anemia if you have heavy periods. • You have a medical condition that affects your body’s ability to make enough red blood cells (red blood cell production.) • You have a medical condition that causes your red blood cells to break down faster than normal. This is hemolysis. What medical conditions affect red blood cell production? Your bone marrow makes stem cells that mature and become red blood cells, along with w...

Anemia of inflammation (AI), also known as anemia of chronic disease (ACD), is regarded as the most frequent anemia in hospitalized and chronically ill patients. It is prevalent in patients with diseases that cause prolonged immune activation, including infection, autoimmune diseases, and cancer. More recently, the list has grown to include chronic kidney disease, congestive heart failure, chronic pulmonary diseases, and obesity. Inflammation-inducible cytokines and the master regulator of iron homeostasis, hepcidin, block intestinal iron absorption and cause iron retention in reticuloendothelial cells, resulting in iron-restricted erythropoiesis. In addition, shortened erythrocyte half-life, suppressed erythropoietin response to anemia, and inhibition of erythroid cell differentiation by inflammatory mediators further contribute to AI in a disease-specific pattern. Although the diagnosis of AI is a diagnosis of exclusion and is supported by characteristic alterations in iron homeostasis, hypoferremia, and hyperferritinemia, the diagnosis of AI patients with coexisting iron deficiency is more difficult. In addition to treatment of the disease underlying AI, the combination of iron therapy and erythropoiesis-stimulating agents can improve anemia in many patients. In the future, emerging therapeutics that antagonize hepcidin function and redistribute endogenous iron for erythropoiesis may offer additional options. However, based on experience with anemia treatment in chronic...

Medical condition Anemia of chronic disease Other names Anemia of chronic inflammation Anemia of inflammation Anemia of inflammatory response Anemia of chronic disease ( ACD) anemia of chronic inflammation anemia of inflammation, anemia of inflammatory response. Classification [ ] Anemia of chronic disease is usually mild but can be severe. It is usually Pathophysiology [ ] Anemia is defined by • < 13.0 g/dL (130 g/L) in males • < 11.5 g/dL (115 g/L) in females In response to inflammatory Before the recent discovery of hepcidin and its function in iron metabolism, anemia of chronic disease was seen as the result of a complex web of inflammatory changes. Over the last few years, however, many investigators have come to feel that hepcidin is the central actor in producing anemia of chronic inflammation. Hepcidin provides a unifying explanation for the condition, and more recent descriptions of In addition to effects of iron sequestration, inflammatory cytokines promote the production of [ citation needed] In the short term, the overall effect of these changes is likely positive: it allows the body to keep more iron away from [ citation needed] Because anemia of chronic disease can be the result of non-infective causes of inflammation, future research is likely to investigate whether hepcidin Anemia of chronic disease may also be due to neoplastic disorders and non-infectious inflammatory diseases. Anemia of chronic disease, as it is now understood, is to at least some degree...

Iron deficiency is the most common cause of anemia and usually results from blood loss; malabsorption, such as with celiac disease, is a much less common cause. Symptoms are usually nonspecific. Red blood cells tend to be microcytic and hypochromic, and iron stores are low, as shown by low serum ferritin and low serum iron levels with high serum total iron-binding capacity. If the diagnosis is made, occult blood loss should be suspected until proven otherwise. Treatment involves iron replacement and treatment of the cause of blood loss. Iron is absorbed in the duodenum and upper jejunum. Iron absorption is determined by its source and by what other substances are ingested with it. Iron absorption is best when food contains heme iron (meat). Dietary nonheme iron is usually in the ferric state (+3) and must be reduced to the ferrous state (+2) and released from food binders by gastric secretions. Nonheme iron absorption is reduced by other food items (eg, vegetable fiber phytates and polyphenols; tea tannates, including phosphoproteins; bran) and certain antibiotics (eg, tetracycline). Ascorbic acid is the only common food element known to increase nonheme iron absorption. The average American diet, which contains 6 mg of elemental iron/1000 kcal of food, is adequate for iron homeostasis. Of about 15 mg/day of dietary iron, adults absorb only 1 mg, which is the approximate amount lost daily by cell desquamation from the skin and intestine. In iron depletion, absorption incre...