Podcast
Questions and Answers
Match the chronic inflammatory diseases with their classification:
Match the chronic inflammatory diseases with their classification:
Rheumatoid arthritis = Non-infectious Pulmonary abscess = Infectious Tuberculosis = Infectious Crohn's disease = Non-infectious
Match the following causes of anemia of chronic disorders with their examples:
Match the following causes of anemia of chronic disorders with their examples:
Malignant disease = Myeloma Chronic liver diseases = Liver cirrhosis Chronic renal failure = Kidney dysfunction Infectious diseases = Bacterial endocarditis
Match the following conditions with their laboratory findings:
Match the following conditions with their laboratory findings:
Anemia of chronic disorders = Increased ESR and CRP Iron deficiency anemia = Low ferritin and high TIBC Sickle cell anemia = Sickle-shaped erythrocytes on smear Megaloblastic anemia = Hypersegmented neutrophils
Match the following regulators of iron homeostasis with their effects:
Match the following regulators of iron homeostasis with their effects:
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Match the following tissue changes with their underlying mechanism:
Match the following tissue changes with their underlying mechanism:
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Match the following diseases with their categorization:
Match the following diseases with their categorization:
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Match the following findings with their description:
Match the following findings with their description:
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Match the following pathophysiological concepts with their roles:
Match the following pathophysiological concepts with their roles:
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Match the following symptoms with their potential underlying cause:
Match the following symptoms with their potential underlying cause:
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Study Notes
Anemia of Chronic Disorders (ACD)
- ACD is a common anemia seen in patients with chronic inflammatory and malignant diseases.
- Patients often have elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
- ACD can be complicated by other hematological changes such as iron or folate deficiency, bone marrow infiltration, hypersplenism or endocrine abnormality.
Causes of ACD
-
Chronic Inflammatory Diseases:
- Infectious: Pulmonary abscess, tuberculosis, osteomyelitis, pneumonia, bacterial endocarditis, and some viral and parasitic infections.
- Non-Infectious: Rheumatoid arthritis, systemic lupus erythematosus, other connective tissue diseases, sarcoid, Crohn's disease, and liver cirrhosis.
- Malignant Diseases: Carcinoma, lymphoma, sarcoma, myeloma.
- Chronic Renal Failure
- Chronic Liver Diseases
Pathogenesis of ACD
-
Decreased Iron Release:
- Hepcidin, a polypeptide produced by the liver, is a key regulator of iron homeostasis.
- Hepcidin inhibits iron release from macrophages and intestinal epithelial cells by binding to ferroportin, a transmembrane iron exporter.
- Elevated hepcidin levels during chronic inflammation significantly impact iron metabolism by reducing its absorption and release.
- Hepcidin synthesis is increased by transferrin saturation and inflammation.
- Hepcidin synthesis is decreased by increased erythropoiesis, erythropoietin, hypoxia, and matriptase.
- Reduced Red Cell Lifespan
-
Inadequate Erythropoietin Response:
- Cytokines (IL-1 & IL-6) and tumor necrosis factor (TNF) levels are raised in chronic inflammation.
- These cytokines suppress erythropoietin secretion, contributing to anemia.
Clinical Features of ACD
- Patients typically present with signs and symptoms of anemia (pallor, dizziness, tiredness, palpitations, etc.) along with symptoms related to their underlying disease.
Laboratory Findings in ACD
- Mild to moderate anemia (hemoglobin rarely < 8 g/dL)
-
Iron Studies:
- Low serum iron
- Low total iron binding capacity (TIBC)
- High serum ferritin
-
Other Findings:
- Increased ESR and CRP
- Mild thrombocytosis
- Normal or slightly elevated reticulocyte count
- Normal or slightly decreased serum vitamin B12 levels
- Normal or slightly decreased serum folate levels
- Normal or slightly decreased red cell folate levels
-
Bone Marrow Aspiration:
- Normocellular with an increase in iron stores in macrophages (ring sideroblasts in some cases).
- May show ineffective erythropoiesis.
Differentiating ACD from Similar Conditions
- Iron deficiency anemia:
- Lower serum ferritin
- Higher TIBC
- Decreased reticulocyte count
- Increased RDW
- Folate deficiency anemia:
- Macrocytic red cells
- Low serum folate levels
- High homocysteine levels
- Abnormal megaloblastic bone marrow
- Vitamin B12 deficiency anemia:
- Macrocytic red cells
- Low vitamin B12 levels
- Elevated methylmalonic acid levels
- Abnormal megaloblastic bone marrow
Treatment of ACD
- Addressing the underlying chronic disease is crucial for anemia management.
- Blood transfusions may be necessary in severe cases of anemia.
- Erythropoietin therapy is often used with caution, especially if the underlying disease is uncontrolled.
- Iron supplementation is usually not effective due to impaired iron utilization in ACD.
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Description
This quiz explores Anemia of Chronic Disorders (ACD), a prevalent condition in patients with chronic diseases. It covers its causes, including chronic inflammatory and malignant diseases, as well as the pathogenesis and complications associated with ACD. Test your knowledge about this important hematological condition.
