Anaemia in primary care: iron deficiency and anaemia of chronic disease

This article will look at iron defciency anaemia and anaemia of chronic disease. Both are problems encountered frequently at a global scale and in the primary care setting. Both conditions can potentially affect any age, although anaemia of chronic disease is more common among older adults. It is hoped that the information provided will give general practice nurses and nurse prescribers greater confidence in the recognition, diagnosis, and management of these conditions, to improve patient care.

Anaemia in primary care: iron deficiency and anaemia of chronic disease

Iron deficiency anaemia and anaemia of chronic disease are commonly seen in primary care. Margaret Perry discusses how to recognise, diagnose and manage these conditions This article will look at iron deficiency anaemia and anaemia of chronic disease. Both are problems encountered frequently at a global scale and in the primary care setting. Both conditions can potentially affect any age, although anaemia of chronic disease is more common among older adults. It is hoped that the information provided will give general practice nurses and nurse prescribers greater confidence in the recognition, diagnosis, and management of these conditions, to improve patient care.

The influence of anaemia on pressure ulcer healing in elderly patients

Anaemia is a common and multifactorial blood disorder in elderly individuals. This condition may be a significant barrier to pressure ulcers healing as it is associated with a decreased level of oxygen being supplied to body tissues. Some nutritional deficiencies such as iron, vitamin B12 and folate may also cause anaemia and have a negative impact on pressure ulcer healing. An increased iron demand in hard-to-heal pressure ulcers is a significant factor associated with the risk of anaemia of chronic disease in elderly patients. Anaemia screening and correction may need to be considered as well as iron supplementation if required in pressure ulcer prevention and management.

Structure of anaemic conditions comorbid to alcoholic and non-alcoholic steatohepatitis

The retrospective analysis of 378 medical records of inpatients with steatohepatitis (SH) depending on its etiology was performed to identify and study the type of anaemic conditions (AC). Among patients with SH of mixed (including alcoholic) etiology anaemia was found in 32.2% of cases, in patients with alcoholic (ASH) - in 36.3%, in patients with non-alcoholic SH (NASH) - in 22.0 % of cases. Macrocytic, hyperchromic anaemia prevailed in patients with anaemia of all groups: in patients with SH of mixed etiology - in 47.9%, in patients with ASH - 56.8%, NASH - 71.4%. Normocytic, normochromic anaemia was registered in 52.1% with mixed etiology of SH, in patients with ASH - 43.2%, NASH - 28.6%.The prospective study of 125 patients with SH showed that anaemia was found in 40.0% of patients with ASH, among patients with SH of mixed (including alcoholic) etiology anaemia was found in 32.0%, among patients with NASH the result was 21.7%. The following types of anaemia were found in ASH: vitamin B12 - deficient - in 17.5% of cases, anaemia of chronic disease - in 10.0% of cases and Zieve's syndrome - in 12.5% of cases. Three types of anaemia were found in patients with SH of mixed etiology: vitamin B12 - deficient - in 16.0% of cases, anaemia of chronic disease - in 8.0% and Zieve's syndrome - in 8.0% of patients. The structure of anaemias in patients with NASH accompanied by obesity of I-II degrees is as follows: B12 - deficient anaemia - in 15.0% of cases, anaemia of chronic disease - in 6.7% of people. In patients with NASH, H. pylory contamination was present in 84.6% of patients with anaemic syndrome (AS), including 100% of patients with B12-deficient anaemia. With ASH, H. pylory contamination was present in 80.0% with anaemia, including 100% of patients with B12-deficient anaemia. In patients with SH of mixed etiology, H. pylory contamination was present in 100.0% of people with AS.

Is Chelation Therapy a Potential Treatment for Parkinson’s Disease?

Iron loading in some brain regions occurs in Parkinson’s Disease (PD), and it has been considered that its removal by iron chelators could be an appropriate therapeutic approach. Since neuroinflammation with microgliosis is also a common feature of PD, it is possible that iron is sequestered within cells as a result of the “anaemia of chronic disease” and remains unavailable to the chelator. In this review, the extent of neuroinflammation in PD is discussed together with the role played by glia cells, specifically microglia and astrocytes, in controlling iron metabolism during inflammation, together with the results of MRI studies. The current use of chelators in clinical medicine is presented together with a discussion of two clinical trials of PD patients where an iron chelator was administered and showed encouraging results. It is proposed that the use of anti-inflammatory drugs combined with an iron chelator might be a better approach to increase chelator efficacy.

Management of Anaemia of Chronic Disease: Beyond Iron-Only Supplementation

Chronic diseases are characterised by altered autophagy and protein metabolism disarrangement, resulting in sarcopenia, hypoalbuminemia and hypo-haemoglobinaemia. Hypo-haemoglobinaemia is linked to a worse prognosis independent of the target organ affected by the disease. Currently, the cornerstone of the therapy of anaemia is iron supplementation, with or without erythropoietin for the stimulation of haematopoiesis. However, treatment strategies should incorporate the promotion of the synthesis of heme, the principal constituent of haemoglobin (Hb) and of many other fundamental enzymes for human metabolism. Heme synthesis is controlled by a complex biochemical pathway. The limiting step of heme synthesis is D-amino-levulinic acid (D-ALA), whose availability and synthesis require glycine and succinil-coenzyme A (CoA) as precursor substrates. Consequently, the treatment of anaemia should not be based only on the sufficiency of iron but, also, on the availability of all precursor molecules fundamental for heme synthesis. Therefore, an adequate clinical therapeutic strategy should integrate a standard iron infusion and a supply of essential amino acids and vitamins involved in heme synthesis. We reported preliminary data in a select population of aged anaemic patients affected by congestive heart failure (CHF) and catabolic disarrangement, who, in addition to the standard iron therapy, were treated by reinforced therapeutic schedules also providing essential animo acids (AAs) and vitamins involved in the maintenance of heme. Notably, such individualised therapy resulted in a significantly faster increase in the blood concentration of haemoglobin after 30 days of treatment when compared to the nonsupplemented standard iron therapy.

Anaemia and acute kidney injury: the tip of the iceberg?

Acute kidney injury (AKI) is a common disorder that complicates the hospital course of many patients. AKI is linked with an independent risk of death, hospital length of stay and chronic kidney disease (CKD). Several preoperative predictors are found to be associated with AKI after surgery independent of its origin (cardiac versus non-cardiac). Among these, anaemia has been widely recognized and studied. Anaemia is more common within the surgical population for various reasons (iron deficiency, blood loss, anaemia of chronic disease such as inflammatory state, malignancy or CKD). Both pre- and postoperative anaemia have a deleterious impact on different clinical outcomes including AKI. In this issue, Nishimoto et al. investigated whether AKI could be a risk factor for anaemia (and not the opposite) and whether anaemia could be an independent mediator of mortality after AKI.

ETIOLOGICAL PROFILE OF 50 CASES 0F ANAEMIA IN CKD

Background and objectives: Anaemia is a common and significant complication of chronic kidney disease (CKD). When present it may cause symptoms such as fatigue and shortness of breath. It is associated with reduced quality of life and increased cardiovascular disease, hospitalizations, cognitive impairment and mortality. As kidney disease progresses, anaemia increases in prevalence affecting nearly all patients with stage V CKD. In patients with CKD, anaemia is defined as the situation in which the concentration of haemoglobin (Hb) in the blood is below 2 times the SD of the mean Hb of the general population. As the pathogenesis of anaemia in CKD is mutlifactorial, this study is intended to know various etiological factors responsible for anaemia in CKD patients. Methods: 50 patients who met with inclusion criteria and exclusion criteria are subjected to detail clinical examination and investigations. Depending upon data obtained, results are evaluated and the percentage of various types of anaemia in CKD was calculated. Results: At the end of study, anaemia of chronic disease (60%) constitutes the commonest cause of anaemia in CKD, followed by iron deficiency anaemia (30%) and megaloblastic anaemia (10%) due to vitamin B12 deficiency. Conclusion: Among 50 cases of anaemia in CKD, anaemia of chronic disease due to erythropoietin deficiency was the most common cause followed by iron deficiency anaemia. Usually clinical examination and routine simple investigations will clinch the diagnosis in most of the cases.

Clinicohematological Study Of Anemia In Geriatric Patients

The present study was conducted in the Hematology section of the Department of Pathology over two years. Two hundred and seventy-three geriatric patients diagnosed as anaemic as per WHO criteria were included in the study—maximum 51.2%number of cases from the age group of 60-65 years. Geriatric anaemia showed slight male preponderance (52.4%) over females (47.6%). Lowest haemoglobin value observed was 3.4 gm/dl, while the highest value was 12.3 gm/dl in males and 11.9 gm/dl in females. Most of the study population presented with moderate grade anaemia (47.6%) Patients requiring hospitalisation (71.8%) outnumbered the patients treated on OPD basis (28.2%). Among the hospitalised patients, moderate grade (51.5%) was common Generalised weakness was the most common symptom (69.6%) followed by fatigue (62.2%). There was a significant association (p= 0.009) observed between the severity of anaemia and dyspnoea Underlying malignancy (20.1%) was the most common comorbid condition among the anaemic subjects. Amongst the 148 cases of anaemia of chronic disease, 120 cases (81%) had normocytic normochromic blood picture, and the majority of the cases had mild anaemia (75 cases-50.6%). Iron deficiency was 2nd leading cause of geriatric anaemia (15.3%); presenting with moderate grade anaemia in a majority (69%). Chronic blood loss was the most common contributing factor for iron deficiency anaemia (61.9%). The incidence of anaemia is quite high among elderly patients, more so when associated with chronic diseases and malignancies. Despite modern diagnostic advances, geriatric anaemia remains underreported and inadequately investigated.