Anemia of Chronic Disease: Pathogenesis

by Carlo Raj, MD

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    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 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.

    02:58 Also, keep in mind that at some point, you might have a patient will present as microcytic.

    03:04 It’s important that you understand that ACD will fall under both categories of microcytic, normocytic.

    03:12 Now the effect seems to be mediated by interleukin-1 and maybe even perhaps interleukin-6.

    03:17 Those are two major interleukins as you know of that are quite involved with inflammatory process.

    03:24 And these are very much involved as well.

    About the Lecture

    The lecture Anemia of Chronic Disease: Pathogenesis by Carlo Raj, MD is from the course Microcytic Anemia – Red Blood Cell Pathology (RBC).

    Included Quiz Questions

    1. Sequestration of iron in bone marrow macrophages
    2. Sequestration of RBCs by spleen
    3. RBC lysis in small vessels
    4. Release of IL-10 and IL-12
    5. Ineffective hematopoiesis in the liver
    1. Hepcidin
    2. C-reactive protein
    3. Transcortin
    4. Transthyretin
    5. Transferrin

    Author of lecture Anemia of Chronic Disease: Pathogenesis

     Carlo Raj, MD

    Carlo Raj, MD

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