scholarly journals Anemia of Chronic Diseases: Wider Diagnostics—Better Treatment?

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1784 ◽  
Author(s):  
Michał Wiciński ◽  
Grzegorz Liczner ◽  
Karol Cadelski ◽  
Tadeusz Kołnierzak ◽  
Magdalena Nowaczewska ◽  
...  
Keyword(s):  
Folic Acid ◽  
Iron Deficiency ◽  
Vitamin B12 ◽  
Chronic Diseases ◽  
Cancer Biology ◽  
Complete Blood Count ◽  
Clinical Status ◽  
Underlying Disease ◽  
Deficiency Anemia ◽  
Hematopoietic Factors

Anemia of chronic diseases is a condition that accompanies a specific underlying disease, in which there is a decrease in hemoglobin, hematocrit and erythrocyte counts due to a complex process, usually initiated by cellular immunity mechanisms and pro-inflammatory cytokines and hepcidin. This is the second most common type of anemia after iron deficiency anemia in the world. Its severity generally correlates with the severity of the underlying disease. This disease most often coexists with chronic inflammation, autoimmune diseases, cancer, and kidney failure. Before starting treatment, one should undertake in-depth diagnostics, which includes not only assessment of complete blood count and biochemical parameters, but also severity of the underlying disease. The differential diagnosis of anemia of chronic diseases is primarily based on the exclusion of other types of anemia, in particular iron deficiency. The main features of anemia of chronic diseases include mild to moderate lowering of hemoglobin level, decreased percentage of reticulocyte count, low iron and transferrin concentration, but increased ferritin. Due to the increasingly better knowledge of the pathomechanism of chronic diseases and cancer biology, the diagnosis of this anemia is constantly expanding with new biochemical indicators. These include: the concentration of other hematopoietic factors (folic acid, vitamin B12), hepcidin, creatinine and erythropoietin. The basic form of treatment of anemia of chronic diseases remains supplementation with iron, folic acid and vitamin B12 as well as a diet rich in the above-mentioned hematopoietic factors. The route of administration (oral, intramuscular or intravenous) requires careful consideration of the benefits and possible side effects, and assessment of the patient’s clinical status. New methods of treating both the underlying disease and anemia are raising hopes. The novel methods are associated not only with supplementing deficiencies, but also with the administration of drugs molecularly targeted to specific proteins or receptors involved in the development of anemia of chronic diseases.

scholarly journals Anemia of chronic diseases as an interdisciplinary problem

2021 ◽  
Vol 40 (2) ◽  
pp. 55-61
Author(s):  
Sergey V. Bondarchuk ◽  
Konstantin P. Golovko ◽  
Dmitriy V. Ovchinnikov
Keyword(s):  
Quality Of Life ◽  
Iron Deficiency ◽  
Chronic Diseases ◽  
Great Part ◽  
Underlying Disease ◽  
Current Data ◽  
Deficiency Anemia ◽  
Pulmonary Insufficiency ◽  
Target Values

Anemia is believed to be a medico-social problem affecting a great part of population. Anemia of chronic diseases represents a considerable number of these disorders, which is particularly challenging for long-standing inflammatory processes, systemic diseases and neoplasms. Pathogenesis of this type of anemia is characterized by complex and miltifactorial nature. Pathogenesis is based on disturbance of erythropoietin synthesis and erythropoiesis precursor cells sensitivity, hyperproduction of factors inhibiting erythropoiesis (tumor necrosis factor, interleukins), disturbance of iron metabolism and other hemopoiesis co-factors. Anemia aggravates associated underlying disease course. Quality of life and overall survival deteriorate. Treatment efficacy for anemia influences the time of patient recovery, as well as success of treatment of other diseases. Iron deficiency and erythropoiesis disturbance, similar to hypoferric anemia, are of great importance. However, iron therapy may aggravate patients condition, hence differential diagnosis of this anemia type and true iron deficiency anemia has a great practical value. In the treatment of anemia in the presence of chronic diseases and anemia in the presence of hematologic diseases, the goal of the treatment is generally limited by the improvement of patients quality of life, target value of hemoglobin for transfusion or erythropoiesis stimulating therapy remaining the subject for discussion. Hemoglobin target determination in individuals with cardiac and pulmonary insufficiency who are on chemotherapy, is critically important, because it is this category of patients that does not demonstrate generally accepted target values of hemoglobin, the level of which is not always indicative of hypoxia absence. The review presents current data on diagnosis, treatment of chronic disease anemia (1 figure, 2 tables, bibliography: 12 refs).

The Etiological Analysis of 100 Case of Aged and Non-Hematological Hospitalized Anemia in Southen China.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3719-3719
Author(s):  
Zhisheng Jiang ◽  
Chunna He ◽  
Hong Zhou ◽  
Qing Wang ◽  
Da Li ◽  
...  
Keyword(s):  
Folic Acid ◽  
Iron Deficiency ◽  
Chronic Diseases ◽  
Iron Deficiency Anemia ◽  
Malignant Tumor ◽  
Bone Fracture ◽  
G6pd Deficiency ◽  
Deficiency Anemia ◽  
Gastrointestinal Tumor ◽  
Very High

Abstract 100 cases of aged non-hematological anemia patients hospitalized in our hospital since July 1, 2000, were analyzed for study on anemia etiology. The mean age was 72.08+/−10.86 (60–90) years (60~ 42; 70~ 39; 80~ 18; 90~ 3) at hospitalization. The etiology of anemia with known showed as followed: Malignant tumor 34: included digestive system malignant tumor 27 (gastric cancer 7, rectal carcinoma 7, colon cancer 6, liver cancer 3, cholangiocarcinoma 2, pencreatic duct cancer 2), lung cancer 3, urinary tract cancer 2, bone sarcoma 2. Iron deficiency anemia 47: digestive tract ulcer 16, hemorrhoid 14. The total number of iron deficiency anemia includes digestive tumors with bleeding. Single nutrition deficiency anemia, macrocytic anemia, i.e. vitamin B12 and/or folic acid deficiency (non-malignant, Non-iron deficiency anemia) 8. Inherited Anemia 10: Thalassemia 6, Glucose-6-phosphate dehydrogenase (G6PD) deficiency 4. Chronic diseases 23: Bone fracture 19, Stroke 18, infection 12, Diabetes 10, Kidney function failure 8, Gynecological bleeding 4. The etiology of anemia is unknown 29: it included some chronic diseases with anemia. Discussion: Incidence of malignant tumor is very high. The incidence of malignancy was 34% in the series of aged anemia. The chance of gene mutation increased as patients’ age getting older. When to diagnose aged anemia, we should better to consider that the primary disease is tumor maybe, and look for tumor carefully. Mechanism of anemia in patients with tumor Gastrointestinal tumor with chronic bleeding that can result in anemia. But, there is serious anemia without bleeding in our series. There were some different chronic diseases in 34 cases of tumor. Researchers have discovered that structural and metabolic disorders were detected in mature erythrocytes in patients with and without anemia in stomach cancer. Anemia development pathways were dependent on enhanced hemolysis of circulating erythrocytes and influx of immature cells from the bone marrow. Complication of etiology in aged anemia Etiological diseases of aged anemia is different and complicate. The major of aged anemia has two or more primary diseases. The primary presenting of gastrointestinal tumor maybe is iron deficiency anemia. The tumor with anemia can result from nutritional deficiency at advance. For example, there were vitamin B12 or/and folic acid 8 cases in our aged series. Some anemia patients in our series complicated cardiac disease, stroke, and bone fracture. 2 cases of G6PD deficiency had primarily diagnosed when they suffered from infection at very old age, 70 years or more in these aged anemia. There are 100 million G6PD in whole world, the incidence is very high especially in Africa and South China. Diagnosis should make as soon as possible. Many advanced tumors were incurable. About 20 per cent of patients with carcinoma of the colon or rectum present with metastatic disease. Surgeons are frequently asked to consider resection or other operative procedures in these patients for palliation. But, average survival was 11.2 months for operative patients versus 6.5 months for nonoperative patients (P < 0.05). So we should better discover tumor anemia and differentiate from other benign anemia in the aged anemia as soon as possible for curable section. To pay attention to treat of etiological diseases is very important for aged anemia patients.

scholarly journals POS0567 HEPCIDIN IS POTENTIAL BIOMARKER TO DISTINGUISH BETWEEN IRON DEFICIENCY ANEMIA AND ANEMIA OF INFLAMMATION IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 518.2-518
Author(s):  
E. Galushko ◽  
A. Semashko ◽  
A. Gordeev ◽  
A. Lila
Keyword(s):  
Rheumatoid Arthritis ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Complete Blood Count ◽  
Deficiency Anemia ◽  
Reactive Protein ◽  
Potential Biomarker ◽  
Serum Hepcidin ◽  
Proper Diagnosis ◽  
Anemia Of Inflammation

Background:Anemia of inflammation (AI) and iron deficiency anemia (IDA) are the two most prevalent forms of anemia in patients with rheumatoid arthritis (RA). Diagnosis becomes challenging if AI is associated with true ID (AI/ID), as there is still a lack of a gold standard for differentiation between AI and AI/ID. However, as therapies to overcome anemia differ, proper diagnosis and understanding of underlying pathophysiological regulations are necessary.Objectives:The aim of the study was to evaluate the clinical efficiency of hepcidin, a key regulator of iron metabolism, in the diagnosis of IDA, as well as the differential diagnosis of AI/ID and AI in patients with RA.Methods:The study was undertaken 96 patients with RA, 67 of them were diagnosed anemia according to WHO criteria (104,3±21,4 g/l). Anemic patients and anemia-free patients with RA (n=29) were comparable (p>0.05) in age (44.4±14.8 and 49.8±9.3 years), disease duration (73.5±65.4 and 59.8±48.3 months) and DAS28 (6.3±1.6 and 5.9±1.9). All cases were subjected to following tests: complete blood count with peripheral smear, serum C-reactive protein, serum interleukin-6, iron studies, serum soluble transferrin receptor (sTfR), and serum hepcidin. Patients with RA and anemia were divided two groups: 25 patients with IDA and 42 - with AI. The AI cases were subdivided into pure AI and AI with coexistent ID (n=15).Results:The mean serum hepcidin concentration was significantly increased in pure AI patients (123.85±25.8 ng/mL) as compared to those in IDA patients (63.9±22.8 ng/mL, P < 0.05) and anemia-free patients with RA (88.1±39.09 ng/mL). Also, compared to pure AI patients [normal sTfR levels (<3 µg/mL)], the serum hepcidin concentration was reduced significantly in AI patients with ID [high sTfR levels (≥3 µg/mL)] with a mean of 79.0±23.97 ng/mL.Conclusion:Hepcidin measurement can provide a useful tool for differentiating AI from IDA and also help to identify an iron deficiency in AI patients. This might aid in the appropriate selection of therapy for these patients.Disclosure of Interests:None declared

scholarly journals Practical guidance for the management of iron deficiency in patients with inflammatory bowel disease

2018 ◽  
Vol 11 ◽  
pp. 175628481876907 ◽  
Author(s):  
Dorothea Niepel ◽  
Thomas Klag ◽  
Nisar P. Malek ◽  
Jan Wehkamp
Keyword(s):  
Iron Deficiency ◽  
Treatment Options ◽  
Intravenous Iron ◽  
Underlying Disease ◽  
Deficiency Anemia ◽  
Diagnostic Tools ◽  
Systemic Complications ◽  
Need For Treatment ◽  
Inflammatory Bowel ◽  
Practical Guidance

Iron deficiency or iron deficiency anemia (IDA) are some of the most common systemic complications of inflammatory bowel diseases (IBD). Symptoms such as fatigue, reduced ability to concentrate and reduced exercise tolerance can mimic common symptoms of IBD and can therefore easily be overseen. Furthermore, clinicians tend to see mild to moderate anemia as an inevitable accompaniment of IBD that is sufficiently explained by the underlying disease and does not require further workup. But in contrast to these clinical routines, current guidelines recommend that any degree of anemia in patients with IBD should be further evaluated and treated. Multiple studies have shown that anemia is a main factor for decreased quality of life (QoL) in patients with IBD. Correction of anemia, however, can significantly improve the QoL of patients with IBD. It is therefore recommended that every patient with IBD is regularly screened for iron deficiency and anemia. If detected, appropriate workup and treatment should be initiated. Over the last years, a number of new diagnostic tools and treatment options have been developed. Multiple studies have demonstrated the safety of newer formulations of intravenous iron in patients with IBD and have compared oral and intravenous iron in various situations. Treatment recommendations have changed and new evidence-based guidelines were developed. However, to date these guidelines are still not widely implemented in clinical practice. The aim of this review is to draw attention to the need for treatment for every level of anemia in patients with IBD and to provide some practical guidance for screening, diagnostics, treatment and follow up of IDA in patients with IBD following current international guidelines.

scholarly journals Iron deficiency anemia and megaloblastic anemia in obese patients

2017 ◽  
Vol 55 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Mahmoud Arshad ◽  
Sara Jaberian ◽  
Abdolreza Pazouki ◽  
Sajedeh Riazi ◽  
Maryam Aghababa Rangraz ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Morbid Obesity ◽  
Iron Deficiency ◽  
Vitamin B12 ◽  
Iron Deficiency Anemia ◽  
Megaloblastic Anemia ◽  
Vitamin B12 Deficiency ◽  
Deficiency Anemia ◽  
Obese Patients ◽  
B12 Deficiency

Abstract Background. The association between obesity and different types of anemia remained uncertain. The present study aimed to assess the relation between obesity parameters and the occurrence of iron deficiency anemia and also megaloblastic anemia among Iranian population. Methods and Materials. This cross-sectional study was performed on 1252 patients with morbid obesity that randomly selected from all patients referred to Clinic of obesity at Rasoul-e-Akram Hospital in 2014. The morbid obesity was defined according to the guideline as body mass index (BMI) equal to or higher than 40 kg/m2. Various laboratory parameters including serum levels of hemoglobin, iron, ferritin, folic acid, and vitamin B12 were assessed using the standard laboratory techniques. Results. BMI was adversely associated with serum vitamin B12, but not associated with other hematologic parameters. The overall prevalence of iron deficiency anemia was 9.8%. The prevalence of iron deficiency anemia was independent to patients’ age and also to body mass index. The prevalence of vitamin B12 deficiency was totally 20.9%. According to the multivariable logistic regression model, no association was revealed between BMI and the occurrence of iron deficiency anemia adjusting gender and age. A similar regression model showed that higher BMI could predict occurrence of vitamin B12 deficiency in morbid obese patients. Conclusion. Although iron deficiency is a common finding among obese patients, vitamin B12 deficiency is more frequent so about one-fifth of these patients suffer vitamin B12 deficiency. In fact, the exacerbation of obesity can result in exacerbation of vitamin B12 deficiency.

scholarly journals Vitamin B12 and Folic Acid Metabolism in Hookworm-Infected Patients

Blood ◽  
1959 ◽  
Vol 14 (12) ◽  
pp. 1269-1279 ◽  
Author(s):  
MIGUEL LAYRISSE ◽  
NORMA BLUMENFELD ◽  
IRIS DUGARTE ◽  
MARCEL ROCHE
Keyword(s):  
Folic Acid ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Acid Metabolism ◽  
Marked Decrease ◽  
Normal Subjects ◽  
Deficiency Anemia ◽  
Hookworm Infection ◽  
Folic Acid Metabolism ◽  
Pteroylglutamic Acid

Abstract Studies on the metabolism of B12 and folic acid were performed in patients with heavy hookworm infection and severe iron deficiency anemia, and in patients with light infection, noninfected patients and normal subjects. Patients with heavy hookworm infection showed a marked decrease of the serum B12 as compared with normal subjects. Eight of 21 cases studied showed values of serum B12 below 100 µµg./ml. Twelve of 13 patients with severe hookworm infection showed impairment of the pteroylglutamic acid intestinal absorption; however, none of them exhibited megaloblastic proliferation in the bone marrow. They all recovered with iron therapy alone. The patients with light infection and the noninfected patients with iron deficiency anemia did not demonstrate significant differences from the normal subjects studied.

Optimizing Clinical Status and Quality of Life With Iron Dextran in Gynecologic Patients With Iron Deficiency Anemia [8L]

2019 ◽  
Vol 133 (1) ◽  
pp. 130S-131S
Author(s):  
Ghadear Shukr ◽  
Haleema Saeed ◽  
Marian Girgis ◽  
Aparna Basu ◽  
Phillip Kuriakose ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Clinical Status ◽  
Deficiency Anemia ◽  
Iron Dextran ◽  
Gynecologic Patients

scholarly journals Reticulocyte size in nutritional anemias

Blood ◽  
1976 ◽  
Vol 48 (5) ◽  
pp. 669-677 ◽  
Author(s):  
DR Clarkson ◽  
EM Moore
Keyword(s):  
Iron Deficiency ◽  
Vitamin B12 ◽  
Mean Corpuscular Volume ◽  
Vitamin B12 Deficiency ◽  
Deficiency Anemia ◽  
Initial Development ◽  
Abrupt Decrease ◽  
Iron Saturation ◽  
Iron Deficient ◽  
B12 Deficiency

Abstract Alterations in reticulocyte size occur 2–3 days after the onset of iron deficient or megaloblastic erythropoiesis and precede, by several weeks, changes in mean corpuscular volume (MCV). Iron-deficiency anemia induced in a normal subject by repeated phlebotomies was characterized by the initial development of larger than normal reticulocytes followed by an abrupt decrease in reticulocyte size. Microreticulocytes appeared 3 days after the fall in per cent iron saturation and antedated the decrease in MCV to below normal by 6 wk. Mean reticulocyte size was disproportionately smaller than normal in patients presenting with iron deficiency. In contrast, reticulocyte size increased abruptly in a patient (and rats) 2–3 days after administration of methotrexate. Mean reticulocyte size was disproportionately larger than normal in patients presenting with folate or vitamin B12 deficiency. Specific replacement therapy with iron, folate, or vitamin B12 was quickly followed by normalization of reticulocyte size.

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