Anemia Of Chronic Disease

(Anemia by iron recycling disorder)

The anemia in the context of chronic disease is a multifactorial process, which is often associated with iron deficiency. In general, a chronic infection, inflammation or tumor disease is present. The anemia is microcytic or normocytic borderline. The values ??of serum transferrin receptor and serum ferritin are between those that are typical of iron deficiency anemia and anemia sideroblastäre. Treatment consists of treating the underlying disorder and if it does not eliminate, the administration of erythropoietin.

Anemia of chronic disease is the second most common form of anemia. In the early stages of the red cells are normocytic, the course they are microcytic. This type of anemia is characterized mainly by the fact that erythropoiesis in the bone marrow is not increased in response to the anemia adequately.

The anemia in the context of chronic disease is a multifactorial process, which is often associated with iron deficiency. In general, a chronic infection, inflammation or tumor disease is present. The anemia is microcytic or normocytic borderline. The values ??of serum transferrin receptor and serum ferritin are between those that are typical of iron deficiency anemia and anemia sideroblastäre. Treatment consists of treating the underlying disorder and if it does not eliminate, the administration of erythropoietin. Anemia of chronic disease is the second most common form of anemia. In the early stages of the red cells are normocytic, the course they are microcytic. This type of anemia is characterized mainly by the fact that erythropoiesis in the bone marrow is not increased in response to the anemia adequately. Etiology This form of anemia occurs mostly in chronic diseases, primarily in infections, inflammatory diseases (especially in rheumatoid arthritis) or malignancy. However, the underlying changes may occur acutely at almost any infection or inflammation. So far, three pathophysiological mechanisms have been described in patients with tumors or chronic granulomatous disease, a slight shortening of the erythrocyte life via unknown mechanisms occurs. By a reduction in erythropoietin production and bone marrow response to erythropoietin leads to disorders of erythropoiesis. There is a malfunction of the intracellular iron metabolism. Reticuloendothelial cells hold iron of degraded red blood cells back and it does not provide for hemoglobin synthesis. Therefore, the anemia can not be compensated by increased erythropoiesis. Cytokines by macrophages released (eg., Interleukin-1?, tumor necrosis factor-?, interferon-?) cause in patients with infection, inflammation and tumor diseases directly or indirectly to a reduction of erythropoietin and an impaired iron metabolism. Diagnostic symptoms and complaints of the underlying disease blood count and serum iron, ferritin, transferrin and transferrin receptor, the clinical signs are usually related to the basic disorder (infection, inflammation or malignancy). Anemia due to chronic disease should be considered when a microcytic anemia or normocytic marginal present in existing chronic infection, inflammatory disease or tumor diseases. There is suspicion of such anemia, the values ??of serum iron, transferrin, transferrin receptor and serum ferritin should be measured. The hemoglobin level is usually> 8 g ??/ dl, unless other circumstances to anemia contribute (differential diagnosis microcytic anemia due to decreased erythropoiesis). In the case of infection, inflammation or cancer serum ferritin levels indicate an additional iron deficiency of just <100 ng / ml. Since there may be as a result of acute phase response to an increase in serum ferritin, wherein serum ferritin> 100 ng / ml of serum transferrin receptor suitable to distinguish between an iron deficiency and anemia associated with chronic disease. Therapy Treatment of the underlying disease recombinant erythropoietin and iron supplementation. (Editor’s note: The administration of erythropoietin is much more limited in Germany!) The focus is on treating the underlying disease. mostly because only a mild anemia is present, there is in most cases not Transfusionspflichtigkeit and may u. U. treated with recombinant erythropoietin. (Editor’s note: The administration of erythropoietin is much more limited in Germany) Since both the Erythropoetinsynthese and the bone marrow response to erythropoietin are disrupted, Erythropoetindosen 150-300 I.U./kg be s.c. requires 3 times a week. A good response is likely if has risen two weeks after initiation of therapy, the hemoglobin value of> 0.5 g / dL and serum ferritin is <400 ng / ml. In order to ensure an adequate response to the Erythropoetingabe, iron supplementation (iron deficiency anemia, therapy) should be performed. However, careful monitoring of hemoglobin response is necessary because adverse effects (eg., Venous thromboembolism, myocardial infarction, death) with hemoglobin levels of> 12 g / dl may occur. Summary Almost any chronic infection, inflammation, or cancer disease can lead to anemia; the hemoglobin level is usually> 8 g ??/ dl, unless circumstances contribute more to anemia. Several factors contribute, including shortened erythrocyte life, disturbed erythropoiesis and impaired iron metabolism. Anemia is initially geringgradig normocytic, microcytic over then. Determination of serum iron, transferrin, transferrin and ferritin. The serum ferritin level is usually> 100 ng / ml, unless it is also an iron deficiency. Treatment of the underlying disease and u. U. administration of recombinant EPO.

Health Life Media Team

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