Pathology
Haematology
Regarding anaemia of chronic disease, which of the following laboratory findings would you NOT expect to see:
Answer:
Anaemia of chronic disease is one of the most common causes of normocytic anaemia. The anaemia is usually mild (Hb > 90 g/L) and non-progressive. Anaemia of chronic disease is usually associated with low serum iron, low transferrin saturation, and a low total iron binding capacity (TIBC) with normal or raised ferritin which differentiates it from iron deficiency anaemia.Anaemia of Chronic Disease
Pathology / Haematology / Anaemia
Last Updated: 23rd May 2023
Anaemia of chronic disease is a common normochromic or mildly hypochromic anaemia, occurring in patients with different inflammatory and malignant diseases.
Causes
- Chronic infections
- Especially osteomyelitis, bacterial endocarditis, TB, chronic abscesses, bronchiectasis, chronic UTI, HIV, AIDs, malaria
- Chronic inflammatory disorders
- Rheumatoid arthritis, polymyalgia rheumatica, systemic lupus erythematosus, scleroderma, inflammatory bowel disease, thrombophlebitis
- Malignancy
- Especially metastatic, lymphoma
- Other
- Congestive heart failure
Pathogenesis
Hepcidin, released by the liver in response to inflammatory cytokines, reduces iron absorption and iron release by macrophages into plasma. Increased level of cytokines also interact directly with accessory marrow stromal cells, macrophages and erythroid progenitors to reduce erythropoiesis, iron utilisation and response to erythropoietin.
Laboratory Features
- Normocytic or mildly microcytic anaemia
- Moderate anaemia (> 90 g/L), severity correlates to severity of underlying disease
- Reduced serum iron
- Reduced total iron binding capacity (TIBC)
- Reduced transferrin saturation
- Normal or raised ferritin (adequate iron stores in bone marrow but stainable iron absent from erythroblasts)
- Raised ESR and CRP
| Anaemia of Chronic Disease | Iron Deficiency Anaemia | |
|---|---|---|
| Serum iron | Low | Low |
| TIBC | Normal/low | High |
| Transferrin saturation | Low | Much lower |
| Ferritin | Normal/high | Low |
Management
The anaemia is corrected by successful management of the underlying disease and does not respond to iron therapy. Recombinant erythropoietin may improve anaemia in patients with e.g. rheumatoid arthritis, cancer and myeloma.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
