A young female has the following lab values s MCV-70 Hb 10 gm% serum Iron 60, serum ferltin 100, the diagnosis Is
Anemia of chronic disease, 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 ferropoin so that access of iron to the circulation is reduced. Other mechanisms may also play a role, such as reduced erythropoiesis Anemia is considered when RBCs count : < 4.5 million in males < 3.9 million in females Or Hemoglobin ( Hb ) content : < 13.5 gm % in males < 11.5 gm % in females In response to inflammatory cytokines, increasingly IL-6, the liver produces increased amounts of hepcidin. Hepcidin in turn causes increased internalisation of ferropoin molecules on cell membranes which prevents release from iron stores. Inflammatory cytokines also appear to affect other impoant elements of iron metabolism, including decreasing ferropoin expression, and probably directly blunting erythropoiesis by decreasing the ability of the bone marrow to respond to erythropoietin. Before the recent discovery of hepcidin and its function in iron metabolism, anemia of chronic disease was seen as the result of a complex web of inflammatory changes. Over the last few years, however, many investigators have come to feel that hepcidin is the central actor in producing anemia of chronic inflammation. Hepcidin offers an attractive Occam's Razor (parsimonious) explanation for the condition, and more recent descriptions of human iron metabolism and hepcidin function reflect this view. In addition to effects of iron sequestration, inflammatory cytokines promote the production of white blood cells. Bone marrow produces both white blood cells and red blood cells from the same precursor stem cells. Therefore, the upregulation of white blood cells causes fewer stem cells to differentiate into red blood cells. This effect may be an impoant additional cause for the decreased erythropoiesis and red blood cell production seen in anemia of inflammation, even when erythropoietin levels are normal, and even aside from the effects of hepcidin. Nonetheless, 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.;(ii) inflammatory cytokines inhibit the release of erythropoietin (EPO) from the kidney; and (iii) the survival of circulating red cells is shoened Ref Davidson 23rd edition pg 845
Thalassemia trail
Chronic iron deficiency anemia
Megaloblastic anemia
Anaemia of chronic infection
Haematology