Anemia of Chronic Disease.doc

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Anemia of Chronic Disease

(Anemia of Inflammation, Iron Reutilization Anemia)

In this factsheet: • The Facts on Anemia of Chronic Disease

• Causes of Anemia of Chronic Disease

• Symptoms and Complications of Anemia of Chronic Disease

• Diagnosing Anemia of Chronic Disease

• Treating and re!enting Anemia of Chronic Disease

The Facts on Anemia of Chronic Disease

The blood that circulates throughout the body performs a number of critical

functions. It deli!ers o"ygen, remo!es car#on dio"ide, and carries life$sustainingnutrients% &y acting as the !ehicle for long$distance messengers (such as hormones),

#lood helps the !arious parts of the #ody communicate 'ith each other% This is carried

out #y #lood cells, 'oring in partnership 'ith the liuid part of the #lood ( plasma)%

*ost of the cells that mae up your #lood are red #lood cells (erythrocytes)% +hite

#lood cells (leukocytes) $ 'hich defend the #ody against foreign matter such as

#acteria, !iruses, and fungi $ are also present%

Anemia occurs when there aren't enough healthy red blood cells in the blood.

*ost anemias are more of a symptom than a disease and can #e the result of a !ariety

of health conditions% +ith any form of anemia, its important to find the cause #eforetreatment #egins%

Anemia of chronic disease develops as a result of a longterm infection or disease.

-sually, it does not cause se!ere anemia% Anemia of chronic disease is thought to #e

the second most common type of anemia, ne"t to iron deficiency anemia% Although

anemia of chronic disease is most often seen in people 'ho ha!e a chronic disease, it

can also appear in young children 'ho only ha!e a simple ear infection% Anemia of

chronic disease may go unnoticed and untreated #ecause the attention is centered on

the disease that is causing it%

In the past, it 'as #elie!ed that anemia of chronic disease 'as associated only 'ithinfections such as syphilis and tu#erculosis% .!er the last /0 years, connections

#et'een the condition and diseases such as rheumatoid arthritis, connecti!e tissue

disorders, chronic infection, trauma, or cancer ha!e also #een esta#lished%

Causes of Anemia of Chronic Disease

Although the e!act cause of anemia of chronic disease is not "nown# it is related

to the effects of chronic diseases on the red blood cells. These conditions cause a

num#er of changes in the #odys red #lood cells% The lifespan of red #lood cells

#ecomes shorter, production of ne' red #lood cells in the #one marro' slo's do'n,and iron is 1'ithheld1 so that it cannot #e used to mae ne' red #lood cells% 2ormally

http://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=1#Factshttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=1#Causeshttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=1#Symptomshttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=2#Diagnosishttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=2#Treatmenthttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=1#Factshttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=1#Causeshttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=1#Symptomshttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=2#Diagnosishttp://chealth.canoe.ca/channel_condition_info_details.asp?channel_id=12&relation_id=1619&disease_id=263&page_no=2#Treatment


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the #ody recycles iron from 1old1 red #lood cells and uses it to mae ne' ones% In

anemia of chronic disease, the #ody does not recycle iron as easily, so it is 1held up1

in the old red #lood cells%

The following are e!amples of conditions that can cause anemia of chronic

disease:

• chronic infections (e%g%, tu#erculosis, lung a#scess, and endocarditis)

• autoimmune diseases or diseases 'ith inflammation (e%g%, rheumatoid arthritis,

lupus, ulcerati!e colitis, Crohns disease, giant cell 3temporal4 arteritis)

• cancers (e%g%, 5odgins disease, lung cancer, #reast cancer)

$ymptoms and Complications of Anemia of Chronic

Disease

There is generally a chronic illness or infection present that causes anemia of

chronic disease# so the symptoms you may e!perience will vary. The primary

condition causing the anemia 'ill ha!e its o'n set of symptoms (such as fe!er in the

case of infection)% Symptoms of the anemia may include pale sin, lac of energy,

fatigue, headache, lethargy (a feeling of 1laziness1), shortness of #reath during

e"ercise, and dizziness%

Since anemia of chronic disease is a secondary condition resulting from a primary

disease, its treatment is often o!erlooed% 5o'e!er, its essential to diagnose and treatit #ecause it may 'eaen the person 'ho has it, maing it harder to reco!er from the

primary disease%

Diagnosing Anemia of Chronic Disease

Anemia of chronic disease isn't usually severe# and symptoms related to the

underlying disease often cover up those of the anemia. This can mae it more

difficult to diagnose%

Accurate diagnosis depends on blood test results such as the following:

• hemoglo#in6 low

• reticulocyte count6 low to normal

• serum ferritin le!el6 normal to elevated

• serum iron6 low

• total iron #inding capacity (TI&C)6 low

A low iron serum level %but a normaltoelevated serum ferritin level& is the most

important and main sign that anemia of chronic disease is present. +ith

inflammation, the le!el of certain plasma proteins called acute phase proteins is

higher in the #lood% The increase in these proteins usually leads to an increase in the #loods sedimentation rate, 'hich is determined #y a #lood test%


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A #one marro' #iopsy may #e performed% +hen e"amining the #one marro', the

most important factor is to measure iron le!els% +ith anemia of chronic disease, iron

stores 'ill #e increased in the #one marro'% This helps in maing the diagnosis

#ecause an increase in iron stores, com#ined 'ith lo' serum iron le!els, is found in

anemia of chronic disease%

Treating and reventing Anemia of Chronic Disease

eople with a chronic disease should be carefully monitored for anemia so that it

can be diagnosed and treated.

In most cases, the type of inflammatory disease or tumour thats causing the anemia

determines the treatment for anemia of chronic disease% It is important to find and

treat the underlying cause of the anemia% .nce all other causes of anemia are ruled out

and the inflammation, infection, or other pro#lem is identified and treated, the anemia

can #e impro!ed%

*edications that are a synthetic form of erythropoietin (e%g%, epoetin alfa7,

dar#epoetin alfa) stimulate the #one marro' to produce more red #lood cells% They

may #e recommended if treatment for the underlying condition isnt effecti!e or

possi#le%

A #lood transfusion may #e needed if the anemia is se!ere, and hormone replacement

therapy may #e used if the anemia is caused #y endocrine failure% +hen the anemia is

caused #y li!er disease, treatment to restore li!er function usually impro!es it%

During the treatment of anemia of chronic disease, its important to consider the possi#ility of other contri#uting factors such as chronic #lood loss or non$a#sorption

of iron, 'hich may cause more se!ere anemia% eople 'ith cancer are often

malnourished and may ha!e an iron deficiency% In these cases, it may or may not #e

necessary to tae iron supplements%

7All medications ha!e #oth common (generic) and #rand names% The #rand name is

'hat a specific manufacturer calls the product (e%g%, Tylenol8)% The common name is

the medical name for the medication (e%g%, acetaminophen)% A medication may ha!e

many #rand names, #ut only one common name% This article lists medications #y their

common names% For more information on #rand names, spea 'ith your doctor or

pharmacist%

CA$( )(*)T

+ear 6 90:: ; ,olume 6 / ; Issue 6 : ; age 6


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Clic here for correspondence address and email

Date of +e#

u#lication

$*ar$

90::

A#stract

Anemia in tu#erculosis is usually anemia of chronic disease% Se!ere hemolytic anemia

is e"ceedingly rare in tu#erculosis patients% +e report a patient diagnosed 'ith

tu#ercular lymphadenitis complicated #y Coom#s positi!e hemolytic anemia% atient

responded 'ell to antitu#erculous treatment% 5ematological parameters impro!ed

after initiation of antitu#erculosis treatment% To the #est of our no'ledge, this is the

first case from India of an adult patient 'ith tu#erculous lymphadenitis presenting'ith Coom#s positi!e hemolytic anemia%

-eywords: Immune hemolytic anemia, Tu#erculous lymphadenitis, Anemia in

tu#erculosis

ow to cite this article:

2andenna!ar *, Cyriac S, ?rishnaumar, Sagar T@% Immune hemolytic anemia in a

patient 'ith tu#erculous lymphadenitis% B @lo#al Infect Dis 90::/6gid%orgte"t%aspE

90::/:


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duration% She also had fatigue and headache% She did not ha!e any history of fe!er or

night s'eats% hysical e"amination re!ealed pallor, icterus, and multiple left cer!ical

lymph nodes% These lymph nodes 'ere firm, nontender, matted, and mo#ile% Systemic

e"amination sho'ed mild splenomegaly% Ga#oratory findings on admission 'ere as

follo's6 hemoglo#in /%H gdG, total +&C count


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Autoimmune hemolytic anemia (AI5A) represents a spectrum of disorders in 'hich

anti#odies against self$antigens on the erythrocyte mem#rane cause a shortened red

#lood cell (R&C) life span% AI5A can occur as an idiopathic (primary) disorder or can

coe"ist 'ith another disease (secondary)% AI5A can also occur follo'ing

administration of certain drugs (drug induced)% The incidence of AI5A is estimated to

#e appro"imately : in :00,000 in adults% 3:4

Tu#erculosis presents 'ith a 'ide !ariety of hematological manifestations% The most

common is normocytic normochromic anemia of chronic disease% Anemia in

tu#erculosis is most often due to nutritional deficiency, mala#sorption syndromes,

failure of iron utilization, and #one marro' suppression% AI5A is e"ceedingly rare in

tu#erculosis%

Siri#addane et al., first reported association of autoimmune hemolytic anemia in

tu#erculous lymphadenitis in :==% 394 A detailed search re!ealed only cases of

AI5A in tu#erculosis in the Mnglish literature / of them responded to anti$

tu#erculous treatment (ATT) alone 'ithout need for #lood transfusion or steroids% 3/4,34

*ehmet Turgut et al.,from Turey, reported a case of pulmonary tu#erculosis 'ith

AI5A responding to ATT alone 'ithout the need for #lood transfusion% 3/4 ing$5ung

?uo et al. from Tai'an, reported an episode of Coom#s positi!e AI5A in a patient

'ith *iliary tu#erculosis resulting in a hemoglo#in of HgdG% 3H4 The hematological

parameters in their case impro!ed 'ithout the use of steroids or #lood transfusion%

&ashi S et al., from India, reported a case of AI5A in childhood tu#erculosis

(mediastinal tu#erculous lymphadenitis), 'hich responded to steroids and

antitu#erculous therapy% 3K4 A#dullah A##a et al., from Saudi Ara#ia, reported AI5A in

an Indonesian housemaid suffering from intestinal tu#erculosis% In their case, AI5A

responded to ATT alone% 34 @upta J et al %, from India, reported a#out a child 'ith

a#dominal tu#erculosis and AI5A, 'hich responded to steroids and ATT% 3


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Authors and Disclosures

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Summary and Introduction

Iron Deficiency

Folate Deficiency

Jitamin &

Anemia of Inflammation

5emoglo#inopathies

ractical Approach to Diagnosis .f Chronic Anemia

References

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Anemia of Inflammation

The anemia of inflammation is an acuired condition that is commonly o#ser!ed in

the clinical settings of infection, arthritis, malignancy, trauma and organ failure%

Initially, the anemia is mild, characterized primarily #y a decrease in the num#er of

red #lood cells% .!er time, the anemia #ecomes more se!ere, 'ith hypochromic,

microcytic erythrocytes%3:or processes in!ol!ed in the pathogenesis of anemia of

inflammation% First, there is a modest (N:0) shortening of red cell sur!i!al 'hich

creates a demand for a slight increase in #one marro' red cell production% The #one

marro' cannot respond adeuately o'ing to impaired erythropoiesis and impairedmo#ilization of iron from the reticuloendothelial cells%3:=4 The impairment of

erythropoiesis, in turn, results from t'o processes6 #lunting of the e"pected increment

in erythropoietin production in response to the degree of anemia, and a decreased

response of the erythroid progenitors to erythropoietin% It is reported that the #lunting

of #one marro' response to erythropoietin may #e mediated #y interleuin$: (IG$:),

tumor necrosis factor a and transforming gro'th factor O, 'hich affect erythropoietin

mR2A transcription%3904 It has also #een demonstrated that IG$:, 'hich is increased

during inflammation, inhi#its erythroid colony$forming units, 'hich later de!elop into

erythro#lasts%39:4

T'o common causes of anemia of inflammation in de!eloping countries are T& and5IJ% Appro"imately, one$third of the 'orlds population is infected #y


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*yco#acterium tu#erculosis% 2inety$fi!e percent of T& cases and =


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5ereditary Spherocytosis 'ith Geg -lcers 5ealing after Splenectomy

ad!ertisement

*.ST .-GAR ARTICGMS ACC.RDI2@ T. -G*.2.G.@ISTS

*ost Mmailed

&ronchial ro!ocation Testing6 The Future

Gung Cancer Deaths Reduced #y CT Scanning, 2ational Trial 5alted

C.D @uidelines6 An -pdate

Gong$acting &eta$agonists in the *anagement of Chronic .#structi!e ulmonary

Disease6 Current and Future Agents

rophylactic Anti#iotic Therapy in Chronic .#structi!e ulmonary Disease

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