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Anaemia

  

  • E J Fitzsimons and J H Brock

    The anaemia of chronic disease

    BMJ, April 7, 2001, 322, p.811-812.


       


    Anaemia of chronic disease was established as a distinct entity in 1962 after studies on the anaemia associated with infection. The ‘big three’ clinical causes are infection, inflammation and neoplasia, which account for 75% of cases. One special case is the anaemia of chronic renal failure which is thought to result from a combination of erythropoietin deficiency and anaemia of chronic disease.

        


    The molecular and cellular mechanisms responsible for anaemia of chronic disease are poorly understood. Three key molecules are involved in iron uptake, storage and use-the transferrin receptor, ferritin and the erythroid haem enzyme 5-aminolaevulinic acid synthase (eALAS). A possible explanation for reticuloendothelial block is that inflammatory mediators interfere with the normal maintenance of iron homeostasis mediated by iron regulatory proteins. Furthermore, ferritin synthesis is transcriptionally upregulated by proinflammatory cytokines and this diverts iron into reticuloendothelial storage rather than release.

       


    Examination of bone marrow for iron is the definitive test for iron deficiency but is uncomfortable and expensive. The measurement of a soluble form of transferrin receptor in serum may now provide an alternative. The developing red cells regulate their iron uptake via expression of transmembrane surface transferrin receptor. Values of both soluble transferrin receptor and the soluble transferrin receptor-ferritin index are raised in iron deficiency anaemia, even in the presence of chronic disease, but are normal or only slightly raised in anaemia of chronic disease.

      


    Authors have shown that soluble transferrin receptor concentrations have high sensitivity and specificity for identifying iron deficiency in anaemic patients with rheumatoid arthritis, and compare well with bone-marrow aspiration as a diagnostic test for absent iron stores in such patients.

      


    Treatment of anaemia of chronic disease generally means treating the underlying disorder. In one condition, however, the response to treatment is dramatic. Hypochromic microcytic anaemia with a dysproteinaemia characterised by increased a-2 globulins and high ESR can be found in temporal arteritis and polymyalgia rheumatica. Treatment with prednisolone rapidly corrects the anaemia and a normal haemoglobin can be maintained long term with low dose steroids.

        

 



 

          

Speciality Spotlight

       

 
Medicine
   

 

Anaemia
  

  • E J Fitzsimons and J H Brock
    The anaemia of chronic disease
    BMJ, April 7, 2001, 322, p.811-812.
       
    Anaemia of chronic disease was established as a distinct entity in 1962 after studies on the anaemia associated with infection. The ‘big three’ clinical causes are infection, inflammation and neoplasia, which account for 75% of cases. One special case is the anaemia of chronic renal failure which is thought to result from a combination of erythropoietin deficiency and anaemia of chronic disease.
        
    The molecular and cellular mechanisms responsible for anaemia of chronic disease are poorly understood. Three key molecules are involved in iron uptake, storage and use-the transferrin receptor, ferritin and the erythroid haem enzyme 5-aminolaevulinic acid synthase (eALAS). A possible explanation for reticuloendothelial block is that inflammatory mediators interfere with the normal maintenance of iron homeostasis mediated by iron regulatory proteins. Furthermore, ferritin synthesis is transcriptionally upregulated by proinflammatory cytokines and this diverts iron into reticuloendothelial storage rather than release.
       
    Examination of bone marrow for iron is the definitive test for iron deficiency but is uncomfortable and expensive. The measurement of a soluble form of transferrin receptor in serum may now provide an alternative. The developing red cells regulate their iron uptake via expression of transmembrane surface transferrin receptor. Values of both soluble transferrin receptor and the soluble transferrin receptor-ferritin index are raised in iron deficiency anaemia, even in the presence of chronic disease, but are normal or only slightly raised in anaemia of chronic disease.
      
    Authors have shown that soluble transferrin receptor concentrations have high sensitivity and specificity for identifying iron deficiency in anaemic patients with rheumatoid arthritis, and compare well with bone-marrow aspiration as a diagnostic test for absent iron stores in such patients.
      
    Treatment of anaemia of chronic disease generally means treating the underlying disorder. In one condition, however, the response to treatment is dramatic. Hypochromic microcytic anaemia with a dysproteinaemia characterised by increased a-2 globulins and high ESR can be found in temporal arteritis and polymyalgia rheumatica. Treatment with prednisolone rapidly corrects the anaemia and a normal haemoglobin can be maintained long term with low dose steroids.
        

 

 

By |2022-07-20T16:42:09+00:00July 20, 2022|Uncategorized|Comments Off on Anaemia

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