tailieunhanh - Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 9)

Anemia of Acute and Chronic Inflammation/Infection (the Anemia of Chronic Disease) The anemia of chronic disease—which encompasses inflammation, infection, tissue injury, and conditions (such as cancer) associated with the release of proinflammatory cytokines—is one of the most common forms of anemia seen clinically and probably the most important in the differential diagnosis of iron deficiency, since many of the features of the anemia are brought about by inadequate iron delivery to the marrow, despite the presence of normal or increased iron stores. This is reflected by a low serum iron, increased red cell protoporphyrin, a hypoproliferative marrow, transferrin saturation in. | Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias Part 9 Anemia of Acute and Chronic Inflammation Infection the Anemia of Chronic Disease The anemia of chronic disease which encompasses inflammation infection tissue injury and conditions such as cancer associated with the release of proinflammatory cytokines is one of the most common forms of anemia seen clinically and probably the most important in the differential diagnosis of iron deficiency since many of the features of the anemia are brought about by inadequate iron delivery to the marrow despite the presence of normal or increased iron stores. This is reflected by a low serum iron increased red cell protoporphyrin a hypoproliferative marrow transferrin saturation in the range of 15-20 and a normal or increased serum ferritin. The serum ferritin values are often the most distinguishing feature between true iron-deficiency anemia and the iron-deficient erythropoiesis associated with inflammation. Typically serum ferritin values increase threefold over basal levels in the face of inflammation. All of these changes are due to the effects of inflammatory cytokines and hepcidin the key iron regulatory hormone acting at several levels of erythropoiesis Fig. 98-4 . Figure 98-4 Neoplasms RBC Source Fauci AS Kasper DL Braunwald E Hauser SL Longo DL Jameson JL Loscalzo J Principles of Interna Medicine t 17th Edition http Copyright The McGraw-Hill Companies Inc. All rights reset . Com Suppression of erythropoiesis by inflammatory cytokines. Through the release of tumor necrosis factor TNF and interferon y IFN- Y neoplasms and bacterial infections suppress erythropoietin EPO production and the proliferation of erythroid progenitors erythroid burst-forming units and erythroid colony-forming units BFU CFU-E . The mediators in patients with vasculitis and rheumatoid arthritis include interleukin 1 IL-1 and IFN-y. The red arrows indicate sites of inflammatory cytokine .