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    Anemia Penyakit Kronik

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    Faridhatul
    1) Anemia of chronic disorders (ACD) is a common type of anemia that occurs in patients with chronic inflammatory conditions, infections, or malignancies. 2) The anemia is caused by decreased iron release from macrophages into the plasma and reduced red blood cell lifespan due to the effects of cytokines like IL-1 and TNF on erythropoiesis. Hepcidin released by the liver in response to inflammation also inhibits macrophage iron release and absorption. 3) Laboratory findings include normochromic normocytic anemia, hypoferremia, normal or elevated serum ferritin, and normal or reduced bone marrow iron stores despite adequate total body iron. Iron therapy is generally not effective for treating A

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    Anemia Penyakit Kronik

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    Faridhatul
    80 views12 pages
    1) Anemia of chronic disorders (ACD) is a common type of anemia that occurs in patients with chronic inflammatory conditions, infections, or malignancies. 2) The anemia is caused by decreased iron release from macrophages into the plasma and reduced red blood cell lifespan due to the effects of cytokines like IL-1 and TNF on erythropoiesis. Hepcidin released by the liver in response to inflammation also inhibits macrophage iron release and absorption. 3) Laboratory findings include normochromic normocytic anemia, hypoferremia, normal or elevated serum ferritin, and normal or reduced bone marrow iron stores despite adequate total body iron. Iron therapy is generally not effective for treating A

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    1) Anemia of chronic disorders (ACD) is a common type of anemia that occurs in patients with chronic inflammatory conditions, infections, or malignancies. 2) The anemia is caused by decreased iron release from macrophages into the plasma and reduced red blood cell lifespan due to the effects of cytokines like IL-1 and TNF on erythropoiesis. Hepcidin released by the liver in response to inflammation also inhibits macrophage iron release and absorption. 3) Laboratory findings include normochromic normocytic anemia, hypoferremia, normal or elevated serum ferritin, and normal or reduced bone marrow iron stores despite adequate total body iron. Iron therapy is generally not effective for treating A

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    © All Rights Reserved
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    80 views12 pages

    Anemia Penyakit Kronik

    Uploaded by

    Faridhatul
    1) Anemia of chronic disorders (ACD) is a common type of anemia that occurs in patients with chronic inflammatory conditions, infections, or malignancies. 2) The anemia is caused by decreased iron release from macrophages into the plasma and reduced red blood cell lifespan due to the effects of cytokines like IL-1 and TNF on erythropoiesis. Hepcidin released by the liver in response to inflammation also inhibits macrophage iron release and absorption. 3) Laboratory findings include normochromic normocytic anemia, hypoferremia, normal or elevated serum ferritin, and normal or reduced bone marrow iron stores despite adequate total body iron. Iron therapy is generally not effective for treating A

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    Anemia of chronic disorders is a common type of anemia that occurs in patients with chronic inflammatory or malignant conditions. It is caused by inhibition of iron absorption and macrophage iron release due to elevated hepcidin levels in response to inflammation.

    Chronic inflammatory diseases, infections like tuberculosis or pneumonia, and malignant diseases like cancer can cause anemia of chronic disorders.

    Laboratory findings include normocytic normochromic anemia, low serum iron, increased ferritin and CRP levels, and normal or increased iron stores in the bone marrow.

    ANEMIA OF CHRONIC

    DISORDERS (ACD)
    FIFY HENRIKA
    Department of Clinical Pathology, Faculty of Medicine,
    University of Indonesia
    Jakarta,
    May 2011, 09

    Module Hematology and Onkology

    IRON
    a.
    b.

    PROTOPORPHYRIN

    Iron deficiency
    Chronic inflammation
    / malignancy

    Sideroblastic anemia

    Haem

    Globin

    Thalassemia
    ( or )
    Haemoglobin

    ANEMIA OF CHRONIC DISORDERS


    (ACD)
    One of the most common anemia occur in
    patients:
    Chronic inflammatory
    Chronic infection
    Trauma
    Renal, hepatic and edocrinologic diseases are not
    consistently associated with abnormalities of iron
    metabolism seen in ACD

    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

    CAUSES OF THE ANEMIA OF CHRONIC


    DISORDERS
    Chronic inflammatory diseases
    Infections (e.g. pulmonary abscess, tuberculosis,
    osteomyelitis, pneumonia, bacterial endocarditis)
    Non-infections (e.g. rheumatoid arthritis,
    systemic lupus erythematosus and other
    connective tissue disease, sarcoidosis, Crohns
    disease
    Malignant diseases
    Carcinoma, lymphoma, sarcoma
    Hoffbrand AV, Moss PAH, Pettit JE. Essential haematology .5th ed. Oxford : Blackwell Publishing; 2006.p.39.

    INVESTIGATION OF A HYPOCHROMIC
    MICROCYTIC ANAEMIA
    MCV / MCH

    BLOOD FILM
    SERUM IRON

    SERUM IRON

    MARROW FOR 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

    normocytic anemia, rarely


    hypochromic microtic anemia

    Serum

    iron , TIBC , saturation index <15%

    BM

    iron stores normal or , serum ferritin


    normal or

    Reduced

    BM sideroblastic iron because


    reduced supply of iron to the marrow
    erythrocyte

    Laboratory findings

    Abnormal plasma protein acute phase response


    IL-1 + other mediators of inflammation
    (Protein synthesis)
    Macrophage
    Complement
    Ferritin
    Phagocytic
    activity

    Hepatocyte
    Acute-phase
    reactans
    Albumin
    Transferrin (TIBC)

    IL-1
    rate
    CRP (ESR) increased
    Erythrocyte
    sedimentation

    The role of lactoferrin in causing hypoferremia.

    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

    Bone marrow iron


    stores
    Erythroblast iron

    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

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