Chronic disease anemia

Anemia of chronic disease Anemia of the elderly Malignant bone marrow disorders Peripheral... 

The underlying cause of anemia (e.g., blood loss iron, folic acid, or B12 deficiency or chronic disease) must be determined and used to guide therapy. 

A decrease in erythrocyte production can be multifactorial. A deficiency in nutrients (such as iron, vitamin B12, and folic acid) is a common cause that often is easily treatable. In addition, patients with cancer and CKD are at risk for developing a hypoproductive anemia. Furthermore, patients with chronic immune-related diseases (such as rheumatoid arthritis and systemic lupus erythematosus) can develop anemia as a complication of their disease. Anemia related to these chronic inflammatory conditions is typically termed anemia of chronic disease. 

Patients with CKD suffer from a decrease in erythropoietin production because erythropoietin is produced mainly in the kidneys.4,5 Finally, in patients with anemia of chronic disease, there is a blunted erythropoietin production as well as a diminished response to erythropoietin.9 Anemia of chronic disease also affects iron homeostasis, causing iron sequestration into storage sites and decreasing the amount available to the rest of the body.9... 

Chronic autoimmune disorders or infections, such as human immunodeficiency virus (HIV) infection or rheumatoid arthritis (anemia of chronic disease)... 

High WBC/platelets may be from anemia of chronic disease, malignancy, or chronic kidney disease. 

FIGURE 63-3. The anemia evaluation process. MCV, mean corpuscular volume Pb, lead TIBC, total iron binding capacity ACD, anemia of chronic disease. 

The underlying cause of anemia (e.g., blood loss iron, folic acid, or vitamin B12 deficiency or chronic disease) must be determined and used to guide therapy. As discussed previously, patients should be evaluated initially based on laboratory parameters to determine the etiology of the anemia (see Fig. 63-3). Subsequently, the appropriate pharmacologic treatment should be initiated based on the cause of anemia. 

Anemia of chronic disease is a term given those with underlying conditions that contribute to or cause anemia in a patient. These chronic diseases can include cancer, chronic... 

Besides anemia associated with cancer and CKD, anemia of chronic disease can result from inflammatory processes and occurs commonly in autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. In treating these types of anemia of chronic disease, the most important principle is treating the underlying disease. These patients also may have iron deficiency and should be treated in the manner already discussed. Erythropoietin therapy such as epoetin-alfa therapy at a dose of 150 units/kg three times a week also may be used in these patients. 

This patient has the subjective symptoms of weight loss, decreased appetite, shortness of breath, and cough. Abnormal laboratory values include elevated temperature, decreased hemoglobin and hematocrit, and decreased CD4 count. Chest x-ray shows diffuse interstitial infiltrates bilaterally. Physical exam reveals thrush. The assessment is possible AIDS with CD4 count of 150 cells/mm3, thrush, a respiratory illness (possibly Pneumocystis jiroveci pneumonia), and anemia of chronic disease. He also has a history of hepatitis B, hypertension, and GERD (on famotidine), poor adherence to his anti hypertensive medications, and likely has an irregular daily regimen due to his occupation as a truck driver. 

Morphologic classifications are based on cell size. Macrocytic cells are larger than normal and are associated with deficiencies of vitamin B12 or folate. Microcytic cells are smaller than normal and are associated with iron deficiency whereas normocytic anemia may be associated with recent blood loss or chronic disease. 

Iron-deficiency anemia can be caused by inadequate dietary intake, inadequate GI absorption, increased iron demand (e.g., pregnancy), blood loss, and chronic diseases. 

Anemia of chronic disease is a hypoproliferative anemia associated with chronic infectious or inflammatory processes, tissue injury, or conditions that release proinflammatory cytokines. The pathogenesis is based on shortened RBC survival, impaired marrow response, and disturbance of iron metabolism. For information on anemia of chronic kidney disease, see Chap. 76. 

Bone marrow failure Anemia of chronic disease Renal failure Endocrine disorders Myelodysplastic anemias... 

Diagnosis of anemia of chronic disease is usually one of exclusion, with consideration of coexisting iron and folate deficiencies. Serum iron is usually decreased but, unlike iron-deficiency anemia, serum ferritin is normal or increased and TIBC is decreased. The bone marrow reveals an abundance of iron the peripheral smear reveals normocytic anemia. 

Laboratory findings of anemia of critical illness disease are similar to those of anemia of chronic disease. 

Treatment of anemia of chronic disease is less specific than that of other anemias and should focus on correcting reversible causes. Iron therapy is... 

Epoetin alfa can be considered, especially if cardiovascular status is compromised, but the response can be impaired in patients with anemia of chronic disease (off-label use). The initial dosage is 50 to 100 units/kg three times weekly. If Hb does not increase after 6 to 8 weeks, the dosage can be increased to 150 units/kg three times weekly. 

In anemia of chronic disease, reticulocytosis should occur a few days after starting epoetin alfa therapy. Iron, TIBC, transferring saturation, or ferritin... 

Generalized/organ specific (lung disease, anemia, decreased blood supply) Cellular hypoxia (cyanide poisoning of electron transport chain in mitochondria) Inflammatory (pathology from abnormal inflammatory response in the body) Autoimmune and/or chronic diseases (systemic lupus erythmatosus, rheumatoid arthritis)... 

Anemia of chronic disease is the second most common form of anemia. Recombinant erythropoietin frequently corrects the anemia with few or no transfusions. Anemia may also develop during radiotherapy or chemotherapy. Recombinant erythropoietin has been shown to increase hematocrit and decrease transfusion requirements after the first month of therapy in anemic cancer patients undergoing chemotherapy. 

In the majority of patients with sickle cell disease, anemia is not the major problem the anemia is generally well compensated even though such individuals have a chronically low hematocrit (20-30%), a low serum hemoglobin level (7-10 g/dL), and an elevated reticulocyte count. Instead, the primary problem is that deoxygenated HbS chains form polymeric structures that dramatically change erythrocyte shape, reduce deformability, and elicit membrane permeability changes that further promote hemoglobin polymerization. Abnormal erythrocytes... 

Blood loss, weak constitution and chronic diseases, various anemias, malnutrition, hypotension, after a surgical operation or delivery of a baby. 

Heart or kidney failure, arthritis, dementia, chronic diseases of the digestive system, anemia, hypotension, hypothyroidism, hypoadrenalism, chronic nephritis, infertility, menopause syndrome, impotence. 

Chronic digestive diseases, anemia, edema, nephritis, hypotension, hypothyroidism, hypoadrenalism, poor nutrition or consuming a low calorie diet. 

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