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Anemia of chronic disease

From Wikipedia, the free encyclopedia
Anemia of chronic dz
Classification and external resources
ICD-9-CM

285.29

MedlinePlus 000565
eMedicine

emerg/734

[edit on Wikidata]
Anemia of chronic disease, or anemia of chronic inflammation, is a form of
anemia seen in chronic infection, chronic immune activation, and malignancy.
These conditions all produce massive elevation of Interleukin-6, which
stimulates hepcidin production and release from the liver, which in turn
reduces the iron carrier protein ferroportin so that access of iron to the
circulation is reduced. Other mechanisms may also play a role, such as
reduced erythropoiesis.

Anemia of chronic inflammation is the preferred term since not all chronic
diseases are associated with this form of anemia.

Contents [hide]
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Pathophysiology

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Survival advantage

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Severity

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Diagnosis

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Treatment

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See also

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References

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External links

Pathophysiology[edit]
Anemia is considered when RBCs count :

however. Before the recent discovery of hepcidin and its function in iron metabolism.< 4. Hepcidin offers an attractive Occam's Razor (parsimonious) explanation for the condition. Bone marrow produces both white blood cells and red blood cells from the same precursor stem cells. many investigators have come to feel that hepcidin is the central actor in producing anemia of chronic inflammation.5 million in males < 3.[citation needed] .[1] the liver produces increased amounts of hepcidin. and probably directly blunting erythropoiesis by decreasing the ability of the bone marrow to respond to erythropoietin. Nonetheless.9 million in females Or Hemoglobin ( Hb ) content : < 13. Therefore. and (iii) the survival of circulating red cells is shortened. there are other mechanisms that also contribute to the lowering of hemoglobin levels during inflammation: (i) Inflammatory cytokines suppress the proliferation of erythroid precursors in the bone marrow. the upregulation of white blood cells causes fewer stem cells to differentiate into red blood cells. and more recent descriptions of human iron metabolism and hepcidin function reflect this view. increasingly IL-6. including decreasing ferroportin expression. (ii) inflammatory cytokines inhibit the release of erythropoietin (EPO) from the kidney. inflammatory cytokines promote the production of white blood cells. Inflammatory cytokines also appear to affect other important elements of iron metabolism. Hepcidin in turn causes increased internalisation of ferroportin molecules on cell membranes which prevents release from iron stores.[2] In addition to effects of iron sequestration.5 gm % in males < 11. This effect may be an important additional cause for the decreased erythropoiesis and red blood cell production seen in anemia of inflammation. anemia of chronic disease was seen as the result of a complex web of inflammatory changes. Over the last few years.5 gm % in females In response to inflammatory cytokines. even when erythropoietin levels are normal. and even aside from the effects of hepcidin.

the effect of locking up iron stores is to reduce the ability of the bone marrow to produce red blood cells. the overall effect of these changes is likely positive: it allows the body to keep more iron away from bacterial pathogens in the body. future research is likely to investigate whether hepcidin antagonists might be able to treat this problem. These cells require iron for their massive amounts of hemoglobin which allow them to transport oxygen. In other words. used to treat HIV infection) that have the side effect of inhibiting erythropoiesis. or the anemia caused by some drugs (like AZT. while producing more immune cells to fight off infection. Anemia of chronic disease may also be due to neoplastic disorders and noninfectious inflammatory diseases. . On the other hand. not all anemia seen in people with chronic disease should be diagnosed as anemia of chronic disease. if inflammation continues. both of these examples show the complexity of this diagnosis: HIV infection itself can produce anemia of chronic disease. and renal failure can lead to inflammatory changes that also can produce anemia of chronic disease. However.In the short term. Almost all bacteria depend on iron to live and multiply.[3] Neoplastic disorders include Hodgkin’s disease lung and breast carcinoma and non-infectious inflammatory diseases include rheumatoid arthritis and systemic lupus erythematosus. [citation needed] Because anemia of chronic disease can be the result of non-infective causes of inflammation. Anemia of chronic disease as it is now understood is to at least some degree separate from the anemia seen in renal failure in which anemia results from poor production of erythropoietin.