Anaemia of Chronic Disease: An In-Depth Review

Abstract

Anaemia is the most common haematological disorder affecting humanity and is usually observed in chronic disease states such as non-specific anaemia, which may cause diagnostic difficulties. In chronically ill patients with anaemia, this has a negative impact on quality of life as well as survival. This paper aims at reviewing the pathogenesis of this form of anaemia with a view to suggesting future targets for therapeutic intervention. The ability to diagnose this disorder depends on the ability of the physician to correlate the possible clinical pathways of the underlying disease with the patients' ferrokinetic state. It is important to rule out iron deficiency and other causes of anaemia as misdiagnosis will in most cases lead to refractoriness to standard therapy. The cytokines and acute-phase proteins play important roles in the pathogenesis of anaemia of chronic disease. Alterations in the metabolism of iron via the molecule hepcidin and ferritin are largely responsible for the consequent anaemia. Concomitant iron deficiency might be present and could affect the diagnosis and therapeutic protocol. Treatment options involve the use of erythropoiesis-stimulating agents, blood transfusion, and iron supplementation, in addition to treating the underlying disease.

Utility of new red cell parameters for distinguishing functional iron deficiency from absolute iron deficiency in children with familial Mediterranean fever

“…These proportions are similar to those in a previous report from Turkey . Among children who are in an inflammatory period of chronic disease, the reported incidence of iron deficiency can range from 13% to 90% . We observed a higher prevalence of AID than FID among children with FMF.…”

“…8 Among children who are in an inflammatory period of chronic disease, the reported incidence of iron deficiency can range from 13% to 90%. 1,2 We observed a higher prevalence of AID than FID among children with FMF. Several genetic mutations have been described for diagnosing FMF.…”

“…Clinicians need to be able to recognize iron deficiency before iron deficiency anemia (IDA) develops in these patients. Functional iron deficiency (FID) is a major component of anemia of chronic disease and occurs in subjects with infection, inflammation, and malignancy . This form of deficiency occurs when there is insufficient iron transport into erythroid precursors despite sufficient body stores of iron during inflammation.…”

The role of iron repletion in adult iron deficiency anemia and other diseases

“…Exogenous EPO is an option for certain patient populations including those with chronic kidney disease, malignancy with chemotherapy‐associated anemia, and low/intermediate‐risk myelodysplastic syndromes with <500 mIU/mL EPO levels . Parenteral iron should be administered in patients with absolute iron deficiency and in those who did not respond to EPO …”

“…35 Parenteral iron should be administered in patients with absolute iron deficiency and in those who did not respond to EPO. 36 Thalassemia syndromes are heritable disorders with a broad range of clinical manifestations caused by mutations in genes responsible for alpha-or beta-globin synthesis, ultimately leading to ineffective erythropoiesis, hemolysis, and splenic sequestration of erythrocytes. 37 Management of severe thalassemia generally consists of chronic blood transfusions and iron chelation therapy when serum ferritin exceeds 800-1000 ng/mL.…”