Anemia of chronic disease laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Shyam Patel [2]Associate Editor(s)-in-Chief: Omer Kamal, M.D.[3]
Overview
Mild normocytic and normochromic anemia with a hemoglobin concentration of 10 to 11 g/dL. Less than 25 percent of the cases have microcytic and hypochromic anemia with a mean corpuscular volume (MCV) less than 70 fL. Normal or low mean corpuscular hemoglobin (MHC) similar to the MCV, and normal to increased red cell distribution width (RDW). No significant changes in the mean corpuscular hemoglobin concentration (MCHC). 20 percent of cases have severe anemia, with a hemoglobin concentration <8 g/dL. Absolute reticulocyte count is frequently low (<25,000/microL). There could be an elevation in cytokines (eg, IL-6, interferon-gamma) and acute phase reactants (e.g. fibrinogen, erythrocyte sedimentation rate, C-reactive protein, ferritin, haptoglobin, factor VIII). .
Laboratory Findings
- Mild normocytic and normochromic anemia with a hemoglobin concentration of 10 to 11 g/dL
- Microcytic and hypochromic anemia with a mean corpuscular volume (MCV) less than 70 fL in less than 25 percent of the cases
- Normal or low mean corpuscular hemoglobin (MHC) similar to the MCV
- Normal to increased red cell distribution width (RDW)
- No significant changes in the mean corpuscular hemoglobin concentration (MCHC)
- Severe anemia, with a hemoglobin concentration <8 g/dL in 20 percent of cases
- Low absolute reticulocyte count (<25,000/microL) in many cases
- Elevation in cytokines (e.g. IL-6, interferon-gamma)
- Elevation in acute phase reactants (e.g., fibrinogen, erythrocyte sedimentation rate, C-reactive protein, ferritin, haptoglobin, factor VIII)
Iron studies
- Low serum iron concentration and transferrin level (also measured as total iron binding capacity, TIBC)
- Normal or low-normal percent saturation of transferrin (TSAT)
- Normal or elevated serum ferritin concentration
Soluble transferrin receptor studies[5][6][7]
- sTfR is normal in patients with ACD.
- It helps to distinguish between Iron deficiency anemia and ACD
- Calculation of the ratio of sTfR (expressed as mg/L) to ferritin (expressed as mcg/L), or the ratio of sTfR to the logarithm (to the base 10) of the ferritin concentration
- A sTfR/log ferritin ratio (TfR-ferritin index) <1 suggests the diagnosis of ACD, while a ratio >2 suggests the presence of IDA . Those with the combination of IDA and ACD will also have a TfR-ferritin index >2.
Peripheral blood smear
- Leukocytosis with a "left shift" (bands and immature forms) in the presence of infection
- Presence of leukemic or malignant cells, or leukopenia/lymphocytopenia in cancer or acute or chronic disorders involving the immune system
Bone marrow studies [9]
- Normal or increased amounts of storage iron in bone marrow macrophages
- Decreased number of sideroblasts
References
- ↑ Gangat N, Wolanskyj AP (July 2013). "Anemia of chronic disease". Semin. Hematol. 50 (3): 232–8. doi:10.1053/j.seminhematol.2013.06.006. PMID 23953340.
- ↑ 2.0 2.1 Weiss G, Goodnough LT (March 2005). "Anemia of chronic disease". N. Engl. J. Med. 352 (10): 1011–23. doi:10.1056/NEJMra041809. PMID 15758012.
- ↑ Vreugdenhil G, Löwenberg B, van Eijk HG, Swaak AJ (1990). "Anaemia of chronic disease in rheumatoid arthritis. Raised serum interleukin-6 (IL-6) levels and effects of IL-6 and anti-IL-6 on in vitro erythropoiesis". Rheumatol. Int. 10 (3): 127–30. PMID 2392639.
- ↑ Macciò A, Madeddu C, Massa D, Mudu MC, Lusso MR, Gramignano G, Serpe R, Melis GB, Mantovani G (July 2005). "Hemoglobin levels correlate with interleukin-6 levels in patients with advanced untreated epithelial ovarian cancer: role of inflammation in cancer-related anemia". Blood. 106 (1): 362–7. doi:10.1182/blood-2005-01-0160. PMID 15774616.
- ↑ Suominen P, Möttönen T, Rajamäki A, Irjala K (May 2000). "Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia". Arthritis Rheum. 43 (5): 1016–20. doi:10.1002/1529-0131(200005)43:5<1016::AID-ANR9>3.0.CO;2-3. PMID 10817554.
- ↑ Koulaouzidis A, Said E, Cottier R, Saeed AA (September 2009). "Soluble transferrin receptors and iron deficiency, a step beyond ferritin. A systematic review". J Gastrointestin Liver Dis. 18 (3): 345–52. PMID 19795030.
- ↑ Infusino I, Braga F, Dolci A, Panteghini M (November 2012). "Soluble transferrin receptor (sTfR) and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia. A meta-analysis". Am. J. Clin. Pathol. 138 (5): 642–9. doi:10.1309/AJCP16NTXZLZFAIB. PMID 23086764.
- ↑ Punnonen K, Irjala K, Rajamäki A (February 1997). "Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency". Blood. 89 (3): 1052–7. PMID 9028338.
- ↑ ELLIS LD, JENSEN WN, WESTERMAN MP (July 1964). "MARROW IRON. AN EVALUATION OF DEPLETED STORES IN A SERIES OF 1,332 NEEDLE BIOPSIES". Ann. Intern. Med. 61: 44–9. PMID 14175842.