Anemia of chronic disease differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Differential Diagnosis
Concomitant iron deficiency
The most important differential is whether the patient has ACD alone or ACD with ongoing iron deficiency anemia (ACD/IDA). The following parameters will distinguish the two:
●Soluble transferrin receptor levels (sTfR) and/or the sTfR-ferritin index sTfR and the sTfR-ferritin index are normal in uncomplicated ACD, while both are elevated when IDA is also present [89].
●Percentage of hypochromic red cells and reticulocyte hemoglobin may help[90,91]
●Bone marrow examination in n difficult cases the diagnosis can often be established by bone marrow examination. Findings in the most common disorders include:
•ACD: Normal to increased iron in bone marrow macrophages while erythroid precursors may show decreased to absent iron
•Iron deficiency: No stainable iron in macrophages and erythroid precursors.
Myelodysplastic syndromes
Single or multi-lineage dysplastic changes with or without increased number of sideroblasts, including ring forms, are commonly seen in patients with myelodysplasia
Sideroblastic anemias
Presence of ring sideroblasts on bone marrow examination
●Serum erythropoietin (EPO) levels lower in ACD than in patients with IDA and comparable degrees of anemia [7]
●Oral iron supplementation for four to six weeks may help in the differentiation between ACD and ACD/IDA.
Chronic kidney disease (CKD)
Anemia in an older adult
Endocrine disorders
Hyperthyroidism, hypothyroidism, panhypopituitarism, and primary and secondary hyperparathyroidism may also present with a normocytic, normochromic hypoproliferative anemia.
Miscellaneous
IDA, thalassemic disorders, sideroblastic anemias, and the sideroblastic variants of the myelodysplastic syndrome [94].