Anemia
of Chronic DiseaseThis form of anemia is the second most common one when
world statistics are analyzed. There is a lack of available iron in the bone marrow
as a result of a systemic inflammation, a chronic infection or due to cancer.
Often these chronic illnesses are also associated with iron deficiencies as well.
There is a combination of several factors that lead to this form of anemia. Measurements
of red blood cell (RBC) survival show that RBC’s live shorter than the normal
120 days. The production of new RBC’s in the bone marrow (called erythropoiesis)
is reduced because of a relative shortage of the RBC producing hormone, erythropoietin,
and because the bone marrow is less responsive to it. In addition the intracellular
metabolism of iron is suppressed. The end result is that the bone marrow cannot
compensate for the anemia by increase RBC production, because of the combination
of reduced erythropoietin production and impaired iron metabolism. Symptoms
Again there are the general symptoms of lassitude, lack of energy and other
symptoms described in the introductory chapter to anemia. On top of this there
are the symptoms associated with the underlying chronic disease. Diagnostic
tests Blood tests include tests of transferrin, transferrin receptor,
serum ferritin and hemoglobin. Details of these tests have to be discussed with
the doctor. Often a referral to a hematologist is necessary. Treatment
The underlying chronic disease needs to be treated to be successful with
the treatment of the anemia of chronic disease. Blood transfusions are rarely
needed. Instead recombinant erythropoietin is given. As both production and bone
marrow sensitivity to erythropoietin are reduced, a higher dose is required. Typically
150 to 300 units per kilogram are given subcutaneously three times per week. A
patient who had an initial hemoglobin of 8.0 micrograms/deciliter and who responded
with an increase to 8.5 micrograms/deciliter or higher, is considered to have
had a good response. Additionally, iron supplements have to be given to increase
the responsiveness of the bone marrow to erythropoietin.
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