Podcast
Questions and Answers
Which of the following mechanisms contributes to the development of anemia in chronic kidney disease (CKD)?
Which of the following mechanisms contributes to the development of anemia in chronic kidney disease (CKD)?
- Enhanced clearance of hepcidin, leading to increased ferroportin activity
- Increased erythropoietin release from the kidneys
- Decreased clearance of hepcidin, resulting in reduced iron absorption from the gut (correct)
- Increased iron absorption from the gut
A patient with rheumatoid arthritis (RA) presents with anemia. Iron studies reveal low serum iron, normal to increased ferritin, and normal or reduced transferrin. Which of the following best explains these findings?
A patient with rheumatoid arthritis (RA) presents with anemia. Iron studies reveal low serum iron, normal to increased ferritin, and normal or reduced transferrin. Which of the following best explains these findings?
- Increased transfer of iron from macrophages to erythroid progenitor cells
- Iron deficiency due to malnutrition secondary to RA
- Hepcidin-mediated reduction in iron absorption and iron transfer from macrophages (correct)
- Increased iron absorption due to the inflammatory response
Which of the following is typically observed in the anemia of the elderly?
Which of the following is typically observed in the anemia of the elderly?
- Increased response to erythropoietin in the bone marrow
- Increased erythropoietin production from the kidney
- Decreased erythropoiesis secondary to low levels of chronic inflammatory cytokines (correct)
- Elevated serum iron levels
A patient with anemia of inflammation would be expected to have which set of lab results?
A patient with anemia of inflammation would be expected to have which set of lab results?
Which of the following is NOT characteristically associated with anemia of chronic disease?
Which of the following is NOT characteristically associated with anemia of chronic disease?
Which of the following best describes the role of inflammatory cytokines in the development of anemia of chronic disease?
Which of the following best describes the role of inflammatory cytokines in the development of anemia of chronic disease?
A patient with chronic liver failure develops anemia. Which of the following is LEAST likely to contribute to their anemia?
A patient with chronic liver failure develops anemia. Which of the following is LEAST likely to contribute to their anemia?
In end-stage renal disease, reduced red blood cell survival may result from an elevation of:
In end-stage renal disease, reduced red blood cell survival may result from an elevation of:
How does anemia of chronic disease typically affect red blood cell indices?
How does anemia of chronic disease typically affect red blood cell indices?
Prior to diagnosing anemia of the elderly, what other conditions should be ruled out?
Prior to diagnosing anemia of the elderly, what other conditions should be ruled out?
Flashcards
Anemia of Chronic Disease
Anemia of Chronic Disease
Mild to moderate; RBCs are normal size or slightly small; often linked to chronic conditions.
Anemia of Inflammation
Anemia of Inflammation
Chronic inflammation causes less iron absorption, less iron transfer, poor response to erythropoietin, and shortened RBC survival.
Anemia of Organ Failure
Anemia of Organ Failure
Kidney, liver, or endocrine problems cause reduced erythropoietin release, leading to less RBC production.
Anemia of the Elderly
Anemia of the Elderly
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Role of Hepcidin
Role of Hepcidin
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Etiology of Anemia of Chronic Disease
Etiology of Anemia of Chronic Disease
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Etiology of Anemia of Organ Failure
Etiology of Anemia of Organ Failure
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Coexisting Deficiencies
Coexisting Deficiencies
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Lab Findings: Inflammation
Lab Findings: Inflammation
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Lab Findings: Elderly
Lab Findings: Elderly
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Study Notes
- Anemia of chronic disease presents as mild to moderate, normocytic or microcytic anemia.
- Ferritin levels are normal to increased, while transferrin levels are normal or reduced.
- It is also referred to as anemia of inflammation.
- Anemia of inflammation is associated with chronic inflammatory diseases like IBD, RA, chronic infections, and malignancy.
- Hepcidin mediates anemia of inflammation.
- Iron absorption from the gut decreases and transfer of iron from macrophages to erythroid progenitor cells in the bone marrow is reduced.
- Erythropoietin response decreases and hemolysins increase, reducing RBC survival
- Inflammatory cytokines increase and RBC production decreases.
- Serum iron is low in anemia of inflammation.
Anemia of Organ Failure
- Anemia of organ failure occurs in patients with chronic kidney disease (CKD), liver failure, and endocrine gland failure.
- Erythropoietin release decreases, resulting in decreased RBC production.
- Serum iron is low in CKD, but normal in liver and endocrine gland failure.
- In CKD, hepcidin clearance decreases, increasing ferroportin degradation and decreasing iron absorption from the gut.
Anemia of the Elderly
- Anemia affects 20% of those 85+ years old.
- Thorough work-up for other causes of anemia needs to occur before diagnosis.
- Results from decreased response to erythropoietin in the bone marrow.
- Erythropoietin production from the kidney decreases.
- Erythropoiesis decreases secondary to low levels of chronic inflammatory cytokines.
- Serum iron is normal.
Signs and Symptoms
- Signs and symptoms are dependent upon the causative condition.
- Suspect in patients with known chronic diseases.
- Coexistent iron deficiency or folic acid deficiency may be present if the patient is significantly anemic.
- Patients undergoing hemodialysis lose both iron and folic acid.
Lab Findings
- Hematocrit rarely falls below 60% of baseline.
- MCV is normal to slightly reduced.
- RBC morphology is usually normal.
- Reticulocyte count is mildly decreased to normal.
- Iron studies are normal in anemias of organ failure and of the elderly.
- Serum iron & transferrin are decreased in anemia of inflammation.
- Transferrin saturation may be significantly decreased.
- Serum ferritin is normal or increased but can be difficult to distinguish from iron deficiency due to the low serum iron.
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Description
Anemia of chronic disease, also known as anemia of inflammation, is associated with chronic inflammatory diseases. Hepcidin mediates this type of anemia by decreasing iron absorption and transfer. Anemia of organ failure occurs in patients with chronic kidney disease, liver failure, and endocrine gland failure.
