Anemia Penyakit Kronik
Anemia Penyakit Kronik
Anemia Penyakit Kronik
DISORDERS (ACD)
FIFY HENRIKA
Department of Clinical Pathology, Faculty of Medicine,
University of Indonesia
Jakarta,
May 2011, 09
IRON
a.
b.
PROTOPORPHYRIN
Iron deficiency
Chronic inflammation
/ malignancy
Sideroblastic anemia
Haem
Globin
Thalassemia
( or )
Haemoglobin
PATHOGENESIS
Anemia to related to decreased release of iron for
macrophage to plasma
Reduced RBC lifespan
In adequate it erythropoietin response to anemia, cause
by effects of cytokine such IL-1, TNF on erythropoiesis
Hepcidin released by the liver in response to inflammation
Inhibits macrophage
release of iron
Inhibits iron
absorption
INVESTIGATION OF A HYPOCHROMIC
MICROCYTIC ANAEMIA
MCV / MCH
BLOOD FILM
SERUM IRON
SERUM IRON
SIDEROBLASTIC
ANAEMIA
SERUM IRON N /
SERUM IRON
HAEMOGLOBIN
STUDIES : Hb F/
HbA2
FERRITIN LEVEL
THALASSAEMIA,
ABNORMAL
HAEMOGLOBIN
Ferritin
Ferritin N /
IRON
DEFICIENCY
ANAEMIA OF
CHRONIC DISORDER
Lewis SM, Bain BJ, Bates I. Dacie and Lewis practical haematology. 9 th ed. London : Churchill Livingstone; 2001.p.582.
LABORATORY FINDINGS
Hypoferremia
Normochromic
Serum
BM
Reduced
Laboratory findings
Hepatocyte
Acute-phase
reactans
Albumin
Transferrin (TIBC)
IL-1
rate
CRP (ESR) increased
Erythrocyte
sedimentation
LABORATORY DIAGNOSIS OF A
HYPOCHROMIC ANAEMIA
Iron deficiency
Chronic inflammatory
or malignancy
MCV
MCH
Serum iron
Reduced in relation to
severity of anaemia
Reduced
Normal or mild
reduction
Reduced
TIBC
Raised
Reduced
Serum transferrin
receptor
Serum ferritin
Raised
Normal/low
Reduced
Normal or raised
Absent
Present
Absent
Absent
Hoffbrand AV, Moss PAH, Pettit JE. Essential haematology .5th ed. Oxford : Blackwell Publishing; 2006.p.39.
TREATMENT
Iron therapy and hematinic agent are
unnecessary
Resolve the underlying inflammatory or
infectious process successfully treated
Anemia will improve with effective
chemotherapy for malignant disease
The anemia response to erythropoietin in
ACD