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ANEMIA OF CHRONIC DISEASE

DEFINITION:

Normocytic and normochronic anemia associated with a wide variety of chronic disorders.

EPIDEMIOLOGY:

incidence: 2nd most common form of anemia worldwide
age of onset:
- any
risk factors:
- see below

PATHOGENESIS:

1. Chronic Diseases

1. Infections

bronchiectasis - osteomyelitis
lung abscess - TB

2. Inflammatory Diseases

Rheumatic Fever, SLE
Rheumatoid Arthritis, Ulcerative Colitis
Sarcoidosis, vasculitic syndromes

3. Neoplasms

hematologic - Hodgkin's Disease, Non-Hodgkin's Lymphoma
solid tumors - neuroblastoma, Wilms' Tumor

2. Pathogenesis

chronic disease
- hyperactive reticuloendothelial system
  - increased RBC hemolysis
  - defective iron reutilization where the reticular cells tenaciously retain iron from senescent RBC's (concomittant reticuloendothelial siderosis)
- hypoactivity of bone marrow with relative inadequate production of erythropoietin

CLINICAL FEATURES:

1. Anemia

mild to moderate
develops slowly over months

2. Underlying Disorders

signs and symptoms of underlying disorders

INVESTIGATIONS:

1. Serum

Hb: normocytic, normochromic, mean = 60-90 g/L
normal or decreased reticulocytes
decreased serum iron and TIBC (elevated transferrin)
increased free erythrocyte protoporphyrin (FEP)
increased copper, WBC, ESR

2. Bone Marrow

normal cellularity and RBC precursors
decreased number of bone marrow sideroblasts
increased hemosiderin level

MANAGEMENT:

1. Supportive

treat underlying disorder and anemia resolves unless associated with an iron deficiency anemia
iron therapy has no role (except if concomittant iron deficiency anemia)
PRBC transfusions have only a temporary effect and are rarely indicated

Pediatric Database - ANEMIA OF CHRONIC DISEASE

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