1

ANEMIA OF CHRONIC
DISORDERS (ACD)

IRON
a.
b.

PROTOPORPHYRIN

Iron deficiency
Chronic inflammation
/ malignancy

Sideroblastic anemia

Haem

Globin

Thalassemia
( or )
Haemoglobin
12/11/16

ANEMIA OF CHRONIC DISORDERS

(ACD)
3

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
12/11/16

PATHOGENESIS
4

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
absorption12/11/16

CAUSES OF THE ANEMIA OF CHRONIC

DISORDERS
5

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
12/11/16
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 /

HAEMOGLOBIN
STUDIES : Hb F/
HbA2

THALASSAEMIA,
ABNORMAL
HAEMOGLOBIN

SERUM IRON
FERRITIN LEVEL

Ferritin

Ferritin N /

IRON
ANAEMIA OF
DEFICIENCY
CHRONIC DISORDER
12/11/16

Lewis SM, Bain BJ, Bates I. Dacie and Lewis practical haematology. 9 th ed. London : Churchill Livingstone; 2001.p.582.

LABORATORY FINDINGS
7

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
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Laboratory findings

Abnormal plasma protein acute phase response

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

Hepatocyte

Ferritin

Acute-phase
reactans

Phagocytic
activity

Albumin
Transferrin (TIBC)

IL-1

CRP

Erythrocyte sedimentation rate (ESR)

increased
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The role of lactoferrin in causing hypoferremia.

12/11/16

LABORATORY DIAGNOSIS OF A
HYPOCHROMIC ANAEMIA
10

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
12/11/16

Hoffbrand AV, Moss PAH, Pettit JE. Essential haematology .5th ed. Oxford : Blackwell Publishing; 2006.p.39.

TREATMENT
11

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
12/11/16

12

THANK YOU

12/11/16