Summary
Anemia of chronic disease (ACD) is probably the most common anemia among hospitalized medical patients. The second most common type of anemia overall (after iron-deficiency anemia) is anemia of chronic disease. The characteristic feature of this sindrome is the occurrence of hypoferremia in the presence of ample reticuloendothelial iron stores. ACD is detined by the presence of this unique combination of findings. Most patients have an underlying infectious, inflammatory, or neo plas tic dis ease that persist for more than one month. Pathogenesis of ACD is built on three prin ci pal ab nor mal i ties: short ened erythrocyte survival, impaired bone marrow response and disturbance in iron metabolism. ACD is one manifestation of the sys temic re sponse to im mu no logic or inflammatory stress, which results in production of various cytokines. The cytokines most often implicated in the pathogenesis of ACD are TNF, IL-1, IL-6 and interferons. The most consistent features are low serum iron and normal or increased serum ferritin levels, reflecting normal or increased iron stores and distinguishing ACD from iron deficiency anemia. Transferrin saturation and serum iron concentration are decreased in both iron deficiency anemia and ACD. Transferrin receptors can be useful in detecting iron defiency and distinguishing it from ACD. In the future, hepcidin assays may aid in the diagnosis of iron deficiency anemija and ACD, probably in combination with existing diagnostic methods. These assays may also help guide the treatment of anemij as with iron, erythropoietin, anticytokine therapies, more intensive hemodialysis.
Keywords: anemia of inflammation, iron deficiency, inflammation, hepcidin, transferrin, ferritin, hemoglobin, soluble transferrin receptors.
