Anemia of Chronic Disease: Pathogenesis

00:01 Moving right along with microcytic anemia, here with anemia of chronic disease, your focus should be exactly that.

00:08 The chronicity of the disease, those underlying the anemia.

00:13 The chronicity is what we’re focusing upon in ACD or anemia of chronic disease.

00:19 Infections, autoimmune diseases, cancers.

00:22 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.

00:33 For example, 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.

00:46 And so what does the body do? Well, unbeknownst to the body, thinking that it’s actually trying to kill off the invader.

00:53 It prevents the release of the iron from our ferritin, but not just the ferritin though.

00:59 But prevents the release of iron in general so that the bacteria will not have – Or the infection doesn’t have access to it.

01:06 But in the process, your patient is going to be suffering from anemia of chronic disease.

01:13 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.

01:25 So before we move on, please understand we’re in the category of microcytic.

01:29 MCV is going to be less than 80.

01:31 Serum iron might be mildly decreased, but not necessarily dramatically.

01:36 And we’ll talk more about that ferritin, all important ferritin.

01:39 Two major things in anemia of chronic disease that you’ll be paying attention to.

01:44 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.

01:58 Diagnostic tool, extremely important.

02:02 Chronic inflammation.

02:03 What does it to? It sequesters the iron in the bone marrow macrophage.

02:07 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 phase reactants.

02:17 And one of these acute phase reactants that we will be spending time with is called hepcidin.

02:21 And this hepcidin then inhibits the release of your iron from the bone marrow macrophage, meaning to say your ferritin.

02:28 I’ll show you how this works soon enough.

02:31 Once again, you’re focus, anemia of chronic disease is the chronicity of the underlying disease.

02:37 And number two, take a look at the ferritin so that you’re able to differentiate between iron deficiency and ACD.

02:44 Now the effect seems to be mediated by interleukin-1 and maybe even perhaps interleukin-6.

02:48 Those are two major interleukins as you know of that are quite involved with inflammatory process.

02:55 And these are very much involved as well.