Moving right along with
here with anemia of chronic disease,
your focus should be exactly that.
The chronicity of the disease,
those underlying the anemia.
The chronicity is what we’re focusing
upon in ACD or anemia of chronic disease.
Infections, autoimmune diseases, cancers.
So what does that mean?
The most important point of your anemia of
chronic disease to get this question right
is a good history, making
sure that you understand
what is the underlying
issue that’s taking place.
if it is an infection that the patient has
been suffering for a long period of time,
understand that that infection,
let’s say it’s a bacteria,
that requires iron for its own metabolism.
And so what does the body do?
Well, unbeknownst to the body,
thinking that it’s actually
trying to kill off the invader.
It prevents the release of
the iron from our ferritin,
but not just the
But prevents the release of iron in general
so that the bacteria will not have –
Or the infection doesn’t have access to it.
But in the process,
your patient is going to be suffering
from anemia of chronic disease.
Extremely common, before we move on,
understand that many of your patients or
most of your patients in a hospital setting
that have such chronic diseases are going
to be suffering from normocytic anemia.
So before we move on, please understand
we’re in the category of microcytic.
MCV is going to be less than 80.
Serum iron might be mildly decreased,
but not necessarily dramatically.
And we’ll talk more about that
ferritin, all important ferritin.
Two major things in anemia of chronic
disease that you’ll be paying attention to.
Number one, the chronicity
and as we walk through this
further, the ferritin,
and how different
this is from anemia –
Or excuse me, anemia being
caused by iron deficiency.
Diagnostic tool, extremely important.
What does it to?
It sequesters the iron in
the bone marrow macrophage.
In other words, think of this
as being the ferritin, okay?
There are certain mediators that
will be released from the liver
known as your acute
And one of these acute phase
reactants that we will be
spending time with is called hepcidin.
And this hepcidin then inhibits
the release of your iron
from the bone marrow macrophage,
meaning to say your ferritin.
I’ll show you how this
works soon enough.
Once again, you’re focus, anemia of
chronic disease is the chronicity
of the underlying disease.
And number two,
take a look at the ferritin so that
you’re able to differentiate between
iron deficiency and ACD.
Also, before we move on,
please make sure that you also keep in mind
that many of your patients that you’ll be
addressing in clinic will have a normocytic
type of anemia of chronic disease.
Also, keep in mind that at some point,
you might have a patient
will present as microcytic.
It’s important that you understand that ACD
will fall under both categories
of microcytic, normocytic.
Now the effect seems to be
mediated by interleukin-1
and maybe even perhaps
Those are two major
interleukins as you know of
that are quite involved
with inflammatory process.
And these are very much involved as well.