Now, common signs and symptoms of anemia,
which means fatigue and tiredness.
Now the laboratory values is what
you want to pay attention to.
Let me walk you through this.
You’re going to find only
mildly decreased hemoglobin,
not something that you would find as
drastic with iron deficiency perhaps.
Next, the RBCs
Let me stop there.
Or mildly microcytic.
Do you understand the
significance of that statement?
That statement right there tells
you anemia of chronic disease
may have an MCV less than 80.
What does that mean to you?
Or you might have a MCV
being between 80 and 100
that puts you in the
category of normocytic.
Under normocytic, interesting enough,
it will come under
Remember, with normocytic, your next step
to come up with the
differential is to ask yourself
is this anemia hemolytic
And so therefore, with
anemia of chronic disease,
it will be normocytic and
it will be non-hemolytic.
“But, Dr. Raj, you told me earlier
that if it is non-hemolytic,
that the bone marrow has been suppressed.
that’s exactly what happens
in anemia of chronic disease.
Anemia of chronic disease,
some of these cytokines and
interleukins that you’re releasing,
therefore causes the bone
marrow to slow things down.
So therefore, your patient may
appear as normocytic, often.
Also keep in mind that
it may also result in –
As we said, lack of iron
availability makes you feel?
Now the RDW,
either normal or slightly increased because
it kind of behaves like microcytic.
So these will be
Normal to increased serum ferritin,
that is another huge bullet point.
So two major bullet points thus far
that we’ve seen in these discussions.
Normal to increased serum ferritin
and the fact that you then would have also
either normocytic or
microcytic type of anemias.
So what’s going on here?
"Why might there be an increase in serum
ferritin, yet you’re telling, Dr. Raj, that
there might be a little bit
of a decrease in iron??
How is that possible?
Because in iron deficiency, tell
me what your ferritin level was?
Decreased because there
wasn’t any iron in your –
Or there is decreased
maybe due to that female
that had menorrhagia.
Maybe there is that
GI bleed or whatever.
You get my point?
So if there’s no iron to begin with,
there should be a decrease in ferritin.
How in the world do we
see no decrease in iron
or ferritin in anemia
of chronic disease?
Isn’t that a good question?
How is this occurring?
Well, this then will take us into our
discussion of your acute phase reactants.
What does an acute phase
reactant mean to you?
It is an acute event that’s taking place
in which your liver is now going to
respond by releasing certain substances.
For example, you’ve heard
of C-reactive protein.
Guess what that is.
That’s acute phase reactant.
Where is it coming from?
It’s coming from the liver.
When would you even consider thinking
about seeing C-reactive protein?
Inflammation, inflammation, inflammation.
A big one there would be something
like a myocardial infarction in fact.
That’s a C-reactive protein.
That is probably the prototype
of acute phase reactant,
but that is not the acute phase
reactant that you’d find with
anemia of chronic disease.
So what is it called?
Well, we’ll take a look at the name
of it, and it’s called hepcidin.
Thus far, the main distinguishing
feature that we’ve seen between
iron deficiency and
anemia of chronic disease
includes the fact that that ferritin
is not decreased in A, C, D.