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Questions and Answers
What is typically observed in the total white blood cell count in cases of severe anemia?
Which of the following treatments is associated with vitamin B12 deficiency?
What hematological finding is commonly associated with severe anemia?
In severe anemia, which of the following red blood cell inclusions may NOT be observed?
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Which marker indicates a deficiency in vitamin B12 when elevated?
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What is a highly specific indicator of iron deficiency?
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What hormone plays a key role in controlling iron absorption and recycling?
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Which of the following is NOT a characteristic laboratory finding of anemia of chronic disorders (ACD)?
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What condition is characterized as a hypoproliferative anemia resulting from underproduction of red blood cells?
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What laboratory finding is considered virtually diagnostic of anemia of chronic disorders (ACD)?
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In anemia of chronic disorders (ACD), which of the following is typically associated with abnormal RBC morphology?
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What is the effect of decreased recycling of iron from macrophages in ACD?
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In patients of childbearing age, what condition can coexist with both iron deficiency anemia (IDA) and anemia of chronic disorders (ACD)?
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Study Notes
Anemia of Chronic Disorders (ACD)
- ACD is the second most common type of anemia after iron deficiency anemia (IDA).
- It is a common complication in patients with inflammation, infection, malignancy, or systemic diseases.
- ACD is a hypoproliferative anemia, meaning red cell production is reduced.
- ACD is not caused by nutritional deficiencies but rather by an imbalance in iron metabolism.
- Hepcidin, a hormone produced by the liver, plays a key role in ACD.
- Hepcidin controls iron absorption and recycling.
- It blocks the release of iron from macrophages, leading to iron deficiency in erythropoiesis.
Laboratory Findings in ACD
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Hematology:
- Mild hypoproliferative anemia with hematocrit usually between 28% and 32%.
- Hemoglobin may be as low as 5 g/dL.
- Peripheral blood smear (PBS) usually shows normocytic normochromic (N/N); However, 25% to 33% of patients may have hypochromic microcytic RBCs.
- Reticulocyte count is not elevated.
- Leukocytes may be elevated (WBC).
- Platelet count is usually normal.
- Bone marrow:
- Increased or normal hemosiderin (iron) levels.
- Decreased sideroblasts (immature red blood cells with iron granules).
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Clinical Chemistry:
- Serum iron and transferrin levels are decreased.
- Total iron-binding capacity (TIBC) and transferrin saturation are decreased or normal.
- Serum ferritin levels are variable.
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Other Findings:
- Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Treatment for ACD
- Blood transfusions may be considered if anemia is severe.
- Recombinant human erythropoietin (rHu-EPO), such as Procrit (epoetin alfa), is a newer treatment option.
Vitamin B12 Deficiency Anemia
- Vitamin B12 deficiency anemia is a megaloblastic anemia caused by a lack of vitamin B12.
- It is characterized by the presence of large, immature red blood cells called megaloblasts.
- The lack of vitamin B12 interferes with DNA synthesis, impacting red blood cell development.
Laboratory Findings in Vitamin B12 Deficiency Anemia
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Hematology:
- Mean corpuscular hemoglobin (MCH) is usually increased in 90% of cases, indicating larger red blood cells.
- Mean corpuscular hemoglobin concentration (MCHC) is usually normal.
- Platelet count is moderately decreased.
- White blood cell count (WBC) shows leukopenia, particularly neutropenia.
-
Peripheral blood smear (PBS):
- Moderate to significant anisocytosis (variation in red blood cell size) and poikilocytosis (variation in red blood cell shape).
- Macrocytic, ovalocytic red cells prominent.
- Metarubricytes (immature red blood cells) may be present.
- Promegaloblasts (immature red blood cell precursors) and nucleated erythrocytes may be observed in cases of severe anemia (hematocrit < 20%).
- Red cell inclusions such as basophilic stippling, Howell-Jolly bodies, and Cabot rings may be present.
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Leukocytes:
- Hypersegmented neutrophils (more than four lobes).
- Increased eosinophils (eosinophilia).
-
Reticulocyte count:
- Less than 1% if untreated.
-
Other:
- Pancytopenia (decrease in all blood cell types) may be seen in advanced cases.
- RDW (red cell distribution width) is high.
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Clinical Chemistry & Immunology:
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Serum vitamin B12 levels:
- Decreased.
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Serum folate levels:
- May be normal or low.
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Serum methylmalonic acid:
- Increased, a specific indicator of vitamin B12 deficiency.
-
Total homocysteine:
- Increased, a more sensitive marker for vitamin B12 deficiency than methylmalonic acid.
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Intrinsic factor blocking antibody (IF-antibody):
- May be present in pernicious anemia, the most common cause of vitamin B12 deficiency.
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Parietal cell antibody (IgG):
- May be present in pernicious anemia.
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Gastrin levels:
- Elevated in pernicious anemia.
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Other:
- LDH and bilirubin levels may be increased.
- Achlorhydria (absence of free hydrochloric acid in gastric fluid) is a universal feature of vitamin B12 deficiency anemia.
-
Serum vitamin B12 levels:
Treatment for Vitamin B12 Deficiency Anemia
- Regular monthly intramuscular injections of at least 100 mcg of vitamin B12 are necessary to correct the deficiency.
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Description
This quiz covers the essential aspects of Anemia of Chronic Disorders (ACD), including its causes, related laboratory findings, and the role of hepcidin in iron metabolism. Understanding ACD is crucial for diagnosing and managing patients with chronic inflammation and systemic diseases. Test your knowledge on this important hematological condition.
