Anaemia Of Chronic Disorders
One of the most common anaemias occurs
in patients with a variety of chronic inflammatory and malignant diseases
(Table 3.6). The characteristic features are:
1. Normochromic, normocytic or mildly hypochromic
(MCV rarely <75 fL) indices and red cell morphology.
2. Mild and non‐progressive anaemia (haemoglobin
rarely <90 g/L) – the severity being related to the severity of the disease.
3. Both the serum iron and TIBC are reduced.
4. The serum ferritin is normal or raised.
5. Bone marrow storage (reticuloendothelial) iron is
normal but erythroblast iron is reduced (Table 3.7).
The pathogenesis of this anaemia
appears to be related to decreased release of iron from macrophages to plasma
because of raised serum hepcidin levels, reduced red cell lifespan and an
inadequate erythropoietin response to anaemia caused by the effects of
cytokines such as IL‐1 and tumour necrosis factor (TNF) on erythropoiesis.
The anaemia is corrected by successful
treatment of the underlying disease and does not respond to iron therapy.
Erythropoietin injections improve the anaemia in some cases. In many conditions
this anaemia is complicated by anaemia resulting from other causes (e.g. iron,
vitamin B12 or folate deficiency, renal failure, bone marrow failure, hypersplenism,
endocrine abnormality, leucoerythroblastic anaemia) and these are discussed in
Chapter 29.
