Anemia of Chronic Disease | Causes, Pathophysiology, Signs & Symptoms, Diagnosis, Treatment

Summary

This lesson covers anemia of chronic disease, focusing on its causes, pathophysiology, symptoms, diagnosis, and treatment. Anemia of chronic disease occurs when chronic inflammatory conditions, such as infections, diabetes, malignancy, and autoimmune disorders, lead to reduced red blood cell production. Key mechanisms involve disrupted iron absorption and utilization due to increased hepcidin levels. Diagnosis involves blood tests, revealing normocytic, normochromic anemia with decreased serum iron and increased ferritin levels. Treatment revolves around managing the underlying disease, with erythropoietin used in specific cases like chronic kidney disease.

Takeaways

• 😀 Anemia of Chronic Disease (ACD) occurs in the context of chronic inflammatory conditions, leading to low red blood cell count or hemoglobin levels.
• 😀 Chronic diseases like infections, diabetes, cancer, autoimmune disorders, liver disease, and kidney disease can all contribute to the development of ACD.
• 😀 Hepcidin, a hormone produced by the liver, increases in chronic inflammation and inhibits iron absorption in the duodenum and release from macrophages, leading to reduced iron availability for red blood cell production.
• 😀 ACD is characterized by normocytic (normal-sized) and normochromic (normal-colored) red blood cells, with decreased serum iron and low transferrin levels.
• 😀 Ferritin levels are typically elevated in ACD because it is an acute-phase reactant that rises in response to inflammation.
• 😀 In ACD, the MCV (Mean Corpuscular Volume) is usually within the normal range (82-100 fL), indicating normocytic anemia.
• 😀 Iron deficiency anemia can be differentiated from ACD by low ferritin and microcytic (small-sized) RBCs in iron deficiency, whereas ACD presents with normal-sized RBCs and elevated ferritin.
• 😀 Common symptoms of ACD include fatigue, weakness, dizziness, pallor, and, in severe cases, shortness of breath and chest pain.
• 😀 The treatment of ACD focuses on addressing the underlying chronic inflammatory condition, such as controlling diabetes, treating infections, or managing autoimmune disorders.
• 😀 In cases of ACD related to chronic kidney disease, erythropoietin (EPO) may be used to stimulate red blood cell production, as kidney disease impairs EPO production.

Q & A

What is anemia of chronic disease (ACD)?

Anemia of chronic disease is a form of anemia that occurs in the context of chronic inflammatory conditions, leading to low levels of red blood cells or hemoglobin. It is caused by disruptions in iron metabolism and red blood cell production due to chronic inflammation.

Which chronic diseases are commonly associated with anemia of chronic disease?

Common chronic diseases associated with ACD include infections (e.g., abscesses), diabetes, malignancies (e.g., cancer), autoimmune conditions (e.g., rheumatoid arthritis, lupus), liver disease, and kidney disease.

What role does inflammation play in anemia of chronic disease?

Chronic inflammation increases the production of hepcidin, a hormone that inhibits iron absorption from the intestines and blocks iron release from macrophages. This reduces the iron available for red blood cell production, contributing to anemia.

How does hepcidin affect iron metabolism in ACD?

Hepcidin inhibits the absorption of iron in the duodenum and prevents the release of stored iron from macrophages. This leads to iron trapping and a decreased availability of iron for the production of red blood cells, contributing to anemia.

How does anemia of chronic kidney disease differ from anemia of chronic disease?

In anemia of chronic kidney disease, the main cause is a reduced production of erythropoietin (EPO) by the kidneys, which leads to a decreased ability of the bone marrow to produce red blood cells. In contrast, anemia of chronic disease is driven by inflammation and iron metabolism issues, not by EPO deficiency.

What are the common symptoms of anemia of chronic disease?

Common symptoms include fatigue, weakness, dizziness, pale skin, decreased concentration, and shortness of breath. In severe cases, patients may experience chest pain or angina, though this is less common.

What blood test results are typically seen in anemia of chronic disease?

In ACD, blood tests often show normocytic (normal-sized) and normochromic (normal color) red blood cells. Iron studies show decreased serum iron, normal or elevated ferritin levels, decreased total iron binding capacity (TIBC), and low transferrin levels.

How can anemia of chronic disease be differentiated from iron deficiency anemia?

The key difference is that in iron deficiency anemia, ferritin levels are low, while in ACD, ferritin is often normal or elevated due to inflammation. Additionally, ACD typically shows normocytic and normochromic anemia, whereas iron deficiency anemia is usually microcytic and hypochromic.

What is the primary treatment for anemia of chronic disease?

The primary treatment for ACD is to address the underlying chronic condition causing the inflammation. Managing conditions such as diabetes, autoimmune diseases, or infections can improve anemia. In some cases, erythropoietin may be used, particularly in anemia related to chronic kidney disease.

What is the role of erythropoietin in treating anemia of chronic kidney disease?

In chronic kidney disease, the kidneys produce less erythropoietin, a hormone that stimulates red blood cell production in the bone marrow. Administering erythropoietin can help increase red blood cell production and treat anemia in patients with kidney disease.