Anaemia of Chronic Disease

Anaemia of Chronic Disease

·        Causes:

o  Chronic infections e.g. TB, SBE, AIDS

o  Chronic inflammatory states e.g. RA, ulcerative colitis

o  Recognise it so patient is not over-investigated

·        Features:

o  Mild to moderate anaemia: 70 – 100 g/L (usually 90 – 100)

o  Normocytic to mild microcytosis

·        Differential diagnosis

o  Fe deficiency

o  Renal impairment

o  Marrow infiltration

o  Haemolysis

·        Iron Studies (highly examinable):

·        Blood results in chronic disease:

o  ­Ferritin 

o  ¯Protein (especially albumin)

o  ­Globulins

·        Pathogenesis 

o  ­RBC destruction ® ¯survival

o  ¯Iron metabolism

o  Impaired erythropoietin response 

o  Cytokines (TNF-a, IL-1, interferons)

·        Treatment

o  Won‟t respond to iron, etc

o  Treat underlying cause

o  Erythropoietin (but very expensive)