Pathology - Anemia of Chronic Disease
Anemia of chronic disease (ACD) is the most common anemia in hospitalized patients. The patho-genesis can involve decreased EPO production in patients with renal illness; however, more typically, as in this example, chronic inflammatory mediators (e.g., tumor necrosis factor-α, interleukin-1) result in increased synthesis and secretion of hepcidin from the liver. Hepcidin limits the release of iron from macrophages, such that it is sequestered from erythrocyte progenitor cells. As there is no actual deficiency of iron levels in the body, ferritin is still high, and the TIBC is low. However, since iron is being held inside macrophages, serum iron and the transferrin percent saturation is low. Erythrocytes may be either normocytic or microcytic. Inflammatory mediators can also influence EPO, further worsening the anemia. Chronic infections (e.g., TB) can also cause ACD. This patient’s anemia arises from many years of RA and is not related to pneumonia, which she is more susceptible to from her RA medications. The disparity between serum iron and serum ferritin is diagnostic. Although not mentioned in this case, patients with RA are also frequently treated with methotrexate, which inhibits tetrahydrofolate and can lead to folate-deficiency anemia.
0 Comments
Leave a Reply. |
Kembara XtraFacts about medicine and its subtopic such as anatomy, physiology, biochemistry, pharmacology, medicine, pediatrics, psychiatry, obstetrics and gynecology and surgery. Categories
All
|