Anaemia Of Chronic Disease: Dairion Gatot, Savita Handayani, Soegiarto Gani

ANAEMIA OF CHRONIC DISEASE Dairion Gatot, Savita Handayani, Soegiarto Gani Divisi Hematologi-Onkologi Medik Departemen Ilmu Penyakit Dalam FK-USU/ RS H.Adam Malik, Medan 2012

DEFINITION * Anemia associated with chronic infection, inflammatory disease, or neoplastic disease * 1 to 2 months of sustained disease is required for anemia to develop. * Anemia is moderate, with a Hb level beetwen 7 and 11 g/dl and rarely symptomatic * Common features are - Low serum iron level - Low serum TIBC - Increased marrow iron stores - Reduced rate of red cell production

PATHOGENESIS * Red cell life span is reduced by 20 to 30 % * Impaired release of iron from macrophages leads to a low level of serum iron and consequent low saturation of transferrin * Prduction of erythropoietin (EPO) is decreased is response to anemia and the erythroid precursors to respond to EPO is impaired

CLINICAL AND LABORATORY FEATURES * Anemia is usually overshadowed by symptoms of the primary disease * Diagnosis depends on laboratory findings: - Initially normochronic, normocytic anemia, hypochromic, microcytic features develop as disease progresses - Low serum iron level and somewhat decreased serum transferrin concentration: decreased % saturation of transferrin - Level serum ferritin, an acute phase protein, inappropriately elevated with respect to storage iron - Bone marrow contains increased storage iron. The M/E ratio is normal, and the % of sideroblast is decreased - In iron deficiency anemia, low serum iron, increased transferrin, decreased storage iron and serum ferritin

DIFFERENTIAL DIAGNOSIS * Dilution anemia, in patient with far advanced neoplastic disease * Drug-induced marrow suppression, or drug-induced hemolysis * Iron dificiency anemia * Anemia of chronic renal failure * Myelophthisic anemia, due carcinoma or lymphoma replacing marrow

THERAPY * No treatment may be necessary * Iron is contraindicatede * Cobalt chlorine and androgenic steroid may be of benefit but have unacceptable side effect * Paked red cell transfussion may be given, if anemia is sympomatic * EPO therapy is effective