Smitha Abraham Case 1.

1- Elio Martinez 6/10/11 Anemia of Chronic Disease Definition: Chronic systemic disease is often associated ith mild to moderate anemia !ormocytic normochromic b"t can #ro$ress to hy#ochromic microcytic

Etiolo$y: - Chronic infection or inflammation - Cancer - %i&er disease -- he#atitis - Chronic 'idney disease ( )has different #atho#hysiolo$y: red"ced #rod"ction of E*+, - A-DS - .he"matoid arthritis/ S%E - Con$esti&e 0eart 1ail"re - 0od$'in2s disease - +steomyelitis - 3acterial endocarditis E#idemiolo$y: -ncidence: Elderly: 114males 10.54females o&er a$e 66

*atho#hysiolo$y: Erythro#oietic defect 7fail"re to stim"late erythro#oiesis in res#onse to decreased n"mber of .3Cs8 0e#cidin- inhibits iron "#ta'e in the d"oden"m/ modifies intestinal absor#tion/ and inhibit iron release from macro#ha$es Mediators of inflammation7 -%6/ 9!1/ -1! $amma8 ca"ses increase of he#cidin -1! $amma also s"##resses try#to#han hich is re:"ired for #rotein synthesis and cell $ro th Decreased try#to#han ca"ses s"##ression of erythroid #ro$enitor cells in bone marro -ron in blood is red"ced; bone marro cannot synthesize 0b -n addition/ lactoferrin 7 hich is released by ne"tro#hils d"rin$ infections/inflammations8 and a#oferritin 7also released in inflammatory/mali$nant conditions8 bind iron < con&erts it to ferritin and decreases its a&ailability for 0b synthesis

Smitha Abraham Case 1.1- Elio Martinez 6/10/11 Anemia of Chronic Disease

Si$ns and Symtoms: Clinical feat"res of "nderlyin$ chronic disease -ron and/or folic acid deficiency can occ"r sim"ltaneo"sly =- blood loss

Dia$nosis: MC> can be normal or sli$htly red"ced Ser"m iron- lo or "nmeas"reable 7?60 mc$/dl8 9ransferrin$ sat"ration ( e@tremely lo Ser"m ferritin o !ormal or increased o ?A0 mc$/% can be indicati&e of coe@istin$ iron deficiency 9-3C ( can belo or normal -ron deficiency is #resent in the bone marro tho"$h increased iron stores else here

Differential Dia$nosis: Can be mista'en for iron deficiency anemia altho"$h it coe@ists ith iron deficiency Ability to meas"re s9f. can differentiate bet een ACD and -DA o Sol"ble transferrin$ rece#tor 7s9f.8 does not res#ond to ACD b"t is res#onsi&e to -DA

9reatment: Most cases/ no treatment necessary 9reatment of "nderlyin$ disorder *"rified recombinant E*+ 7e#oein alfa8 is effecti&e for o Anemia of 'idney fail"re o Anemia of cancer o Anemia associated ith rhe"matoid arthritis E#oetin alfa inBected s"bc"taneo"sly o -s &ery e@#ensi&e o A0/000 "nits once ee'ly Darbe#oetin ( A00 mc$ e&ery 5-A ee's

Smitha Abraham Case 1.1- Elio Martinez 6/10/11 Anemia of Chronic Disease Erythro#oietin is &ery e@#ensi&e and sho"ld only be "sed hen #t. is transf"sion de#endant .E1E.E!CES: McCance/ C.%./ 0"ether/ S.E./ *atho#hysiolo$y: 9he 3iolo$ic 3asis for Disease in Ad"lts and Children 6th ed./ #$s.DE6-DEF Mc*hee/*a#ada'is/ .abo / 5011 C"rrent Medical Dia$nosis <9reatment/ #$s. EF5-EFA