Majid mossahebi

The terms anemia of chronic disease or chronic disorders refer to mild to moderately severe anemias ([Hb] 7-12 g/dl) associated with chronic infections and inflammatory disorders and some malignancies.

The newer name for this anemia is anemia of

inflammation(AI).

AI is characterized by:• Inadequate erythrocyte production • Low serum iron • Low binding capacity (i.e low transferrin) The erythrocytes usually are normocytic and normochromic but can be mildly hypochromic and microcytic.

The high prevalence of infectious diseases worldwide and the high prevalence of inflammatory and malignant disorders in the industrialized countries suggest that AI is the second or third most common form of anemia after iron-deficiency anemia (IDA) and thalasemia .

In the chronic setting , AI predominantly results from the bodies inability to increase erythrocyte production to compensate for relatively small decrements in erythrocyte survival .

Red cell destruction Inadequate erythropoietin secretion and resistance

to erythropoietin Erythropoiesis as a result of iron unavailability

• Interleukin -6 ,Hepcidin ,and Hypoferremia

• Serum iron concentrations are dependent on iron released from Macrophages and Hepatocytes • Erythropoiesis in anemia of inflammation is limited by iron • Inhibition of Intestinal absorption of iron

The clinical manifestations of AI usually are obscured by the signs and symptoms of the underlying disease.

Moderate anemia (Hg<10) can exacerbate the

symptoms of the preexisting ischemic heart disease or respiratory disease.

The erythrocytes in AI are normocytic and normochromic but , with increasing severity and duration , can become hypochromic and eventually microcytic .The absolute reticulocyte count is normal or slightly elevated .•Hypoferremia and decreased serum transferrin • Interleukin -6 ,Hepcidin ,and Hypoferremia

• Marrow iron stain

• Increased serum ferritin

Hypoferremia , decrease in the serum iron concentration , is a defining feature of AI .

•Moderately decreased

The decreased in transferrin concentration develops more slowly than the decreas in the iron levels because of the longer half-life of transferrin (8-12 days ) compared to the half-life of iron ( approximately 90 minutes )

Serum ferritin concentrations , which reflects iron stores , are increased in AI but decreased in Iron deficiency .

Marrow aspiration or biopsy is rarely required for diagnosis of AI . In general , the marrow morphology and stainable iron are normal , unless the underlying disease alters the picture .

The most important information that obtained from marrow examination is the content of and distribution of iron .

Iron in marrow preparation Functional iron in the nucleated

red cells

Hypoferremia and decreased serum transferrin

Most patients with chronic infections , inflammatory diseases , or neoplastic disorders are anemic .The diagnosis of AI should be made only if the anemia is mild to moderate ,the serum and iron – binding capacity are low , and the serum ferritin is elevated .I. Drug-induced marrow suppression or drug-induced

hemolysis

II. Chronic blood loss

III. Renal impairment

IV. Endocrine disorders

V. Anemia resulting from metastatic invasion of the bone marrow

VI. Thalassemia minor

VII.Dilution anemia

Anemia that presents in the setting of infection , inflammation , or malignancy requires sufficient diagnostic studies to rule out the reversible and potentially more threatening causes , such as occult hemorrhage ; iron , B12 , and folate deficency ; hemolysis and drug reaction .

If the anemia can be designated as AI after such studies ,effective treatment of the underlying disease resolves the anemia