Anemia of chronic disease (also called anemia of inflammation) is a common type of pathology that develops in patients suffering from one or another infectious, inflammatory or neoplastic disease. A distinctive feature of such anemia is a decrease in serum iron, but, unlike a true lack of iron, this trace element can be stored in macrophages.
Description of the disease
Anemia of chronic disease is currently the most common problem. This type of disease is second only to iron deficiency anemia. This pathology can accompany any infectious, rheumatic or tumor disease, and, in addition, heart failure, chronic kidney disease, diabetes, cirrhosis of the liver, and so on.
Anemia of chronic disease (ACD) is defined as an infectious process that is associated with microbial pathogens (bacterial, viral orfungal infections), and in addition, with autoimmune diseases, in particular, with systemic lupus, rheumatoid arthritis and others. Anemia of chronic pathologies also leads to chronic diseases that are accompanied by inflammation of a low grade, for example, oncological neoplasm, chronic kidney disease, heart failure, and the like. In addition, there is a similar pathogenesis of anemia of chronic diseases during aging, against the background of which activation of inflammatory cytokines is noted in patients.
Pathophysiological mechanism
Studies that have been carried out in recent decades allow us to establish the pathophysiological mechanism of anemia of chronic diseases. Diseases that are accompanied by iron deficiency are very numerous. But the main thing is iron deficiency along with ACD.
Difficulty for physicians is primarily the differential diagnosis of anemia of chronic diseases. In the presence of anemia of chronic pathologies, there is a hypochromic hemoglobin deficiency with a low serum iron, but with increased ferritin. It should be noted that the treatment of such anemia with iron preparations does not lead to compensation of erythropoiesis. The use of modern diagnostic studies allows improving and accelerating the diagnosis of anemia.
Given that anemia of chronic diseases is a secondary manifestation of the underlying disease, the therapy of the latter also corrects anemia. Truth,such therapy is not always possible. The modern trend in medicine is the study of molecules of new drugs, whose targets are the main pathogenetic links of chronic diseases, especially cytokines, along with correctors of the ferroportin branch. But most drugs are still at the experimental stage.
Anemia of chronic disease is a blood picture
The picture of blood in the described disease is observed as follows:
- The level of serum iron is reduced.
- If a patient has anemia of chronic diseases, the iron-binding capacity of red blood cells will be reduced. If this indicator is increased, then hemoglobin deficiency can be excluded. True, a change in this value is not a specific sign in order to differentiate anemia of chronic diseases from iron deficiency disease.
- With this diagnosis, serum transferrin saturation is usually normal. A value above ten percent indicates a decrease in iron. And an indicator of less than ten percent indicates the presence of a deficiency of this trace element. Iron deficiency disease can be largely associated with gastrointestinal bleeding due to the treatment of refractory anemia with non-steroidal anti-inflammatory drugs.
- With this disease, serum ferritin is usually normal or elevated in contrast to iron deficiency.
- If you have rheumatoid arthritis,liver diseases or on the background of neoplasms, the normal value of serum ferritin does not exclude concomitant iron deficiency. True, a ferritin level of less than 40 nanograms per milliliter indicates a significant decrease in body iron stores.
- Such an indicator as free erythrocyte porphyrin, in the presence of anemia of chronic pathologies will be increased.
Symptomatics
Anemia of chronic pathologies due to its slow development and mild course, as a rule, practically does not give any symptoms. Any manifestations are usually related to those ailments against which or as a result of which anemia occurs in the body.
So, the symptoms that are characteristic of developing anemia include the presence of increased body fatigue in patients along with its general weakness and a sharp decrease in efficiency. Among other things, the characteristic symptomatology should include obvious irritability with frequent dizziness, drowsiness, noise sensations in the ears, flies before the eyes, heart palpitations and shortness of breath during exertion or even at rest.
Thus, in the event of such symptoms, you should start sounding the alarm and consult a doctor for the necessary diagnostic tests and further adequate treatment.
It is better to find out in advance what anemia is and why this pathology is dangerous.
Diagnosis of pathology
Anemia is commoncertain common features. Usually this is the presence of mild normocytic anemia, when hemoglobin is kept in the region of more than 90 grams per liter. Such anemia develops within the first two months in the presence of infections, inflammatory pathology, or against the background of a malignant formation, while it does not progress. With a hemoglobin index below 80 grams per liter, one should think about the presence of additional factors that are involved in the pathogenesis of anemia. In addition, the severity of anemia can often correlate with the duration and activity of the underlying disease (chronic infection, connective tissue disease, and so on).
What do diagnostic methods depend on?
All methods used to diagnose anemia of chronic diseases directly depend on the most basic disease, against which iron deficiency develops in the body. But, nevertheless, in the event that anemia occurs, then it is mandatory for patients to take a general and biochemical blood test along with a bone marrow puncture in order to establish the nature and type of anemia.
Among other things, during the diagnosis, it is necessary to exclude such causes of iron deficiency as the presence of traumatic bleeding and internal blood loss.
Patient complaints
When collecting complaints from patients, as a rule, they find out that the patient has the following symptoms:
- Palpitations and shortness of breath, worse with exertion.
- Dizziness and tinnitus.
- Weakness and fatigue.
Howanemia of a chronic disease is being treated (according to ICD-10, by the way, the disease code is D63.8)?
Providing treatment
Given that anemia of chronic diseases is a secondary manifestation of the underlying disease, the therapy of the latter will also correct iron deficiency. However, such therapy is not always possible. The principles of managing patients with anemia of chronic pathologies include the following points:
- Treatment of underlying disease.
- Using specific anemia treatments. These are prescribed only in the presence of a severe degree of the disease, which limits the ability to work along with the patient's daily activity.
- When severe anemia develops, red blood cell transfusion is prescribed.
- Prescribing erythropoiesis-stimulating drugs in combination with intravenous iron medications.
- Treatments may additionally include various innovative erythropoiesis-stimulating agents along with anti-cytokine drugs and drugs that affect hepcidin and ferroportin.
It is worth noting that the pathology is not a registered indication for prescribing erythropoiesis-stimulating drugs to patients, however, they can be considered as an alternative treatment to replace multiple red blood cell transfusions. Some studies report positive results from the use of erythropoiesis-stimulating agents in the treatment of anemia of chronic disease.
In case of insufficiencyhearts
Among patients with chronic heart failure, the prevalence of anemia is thirty-seven percent. Among this number, more than half of patients have anemia of chronic disease. Overall, the overall prevalence of iron deficiency disease in patients with heart failure ranges from fourteen to fifty-six percent. Such a wide range is directly related to the lack of a single approved approach to the diagnosis of anemia, and, in addition, to age differences in patients.
Normocytic anemia
Currently, it has been proven that patients suffering from heart failure are more likely to have normocytic anemia, which accounts for up to fifty-seven percent of cases. Most often, this disease is associated with kidney dysfunction and a decrease in erythropoietin secretion. The chronic course of the disease is characterized by poor utilization of iron along with pronounced activation of cytokines, which today occurs in fifty-three percent of patients.
The occurrence of anemia in chronic heart failure is usually promoted by the occurrence of iron deficiency in the blood. It is now proven that the main causes of anemia in patients with heart failure are hemodilution along with chronic kidney disease and vitamin B12 deficiency.
Clinical guidelines for anemia of chronic disease
These include all methods of preventing chronic diseasesand their relapses. One of the recommendations is to maintain a proper and balanced diet rich in iron. Thus, for the prevention of any anemia, doctors recommend focusing on meat and fish dishes, since they contain the largest amount of this microelement, which is so necessary for the body. In this regard, it should be noted that, in particular, the most iron is found in red meats, such as beef. Do not forget about fruits, for example, your preference should be given to apples, pomegranates and so on.
Everyone knows that movement along with walking is an excellent preventive measure in the presence of any disease. In this regard, in order to prevent the symptoms of unpleasant anemia, it is extremely important to regularly maintain your body in good shape. Moderate physical activity in the form of fitness, aerobics, swimming and skiing significantly improves blood circulation, contributing to overall well-being.
Outdoor walks
Among other things, we must not forget that any anemia is primarily a lack of oxygen. Therefore, the best prevention of anemia is the ability to replenish oxygen in the body. To do this, doctors advise a lot of walking in the fresh air. Unfortunately, at present, most people have a sedentary job, many are constantly in a stuffy room, and this all certainly affects the he alth of the body and does not affect it in the best way.
Conclusion
All of the above recommendations are quite effective in the presence of iron deficiency of any kind, including anemia of chronic diseases. The main thing is that all these recommendations are quite simple, and absolutely everyone can follow them. You can, of course, periodically use iron-containing preparations for prevention, but it should be noted right away that it is still not worth abusing them. Therefore, it is best to prevent a disease that can cause iron deficiency in the body through the banal conduct of a he althy lifestyle.
We found out what anemia is and why this disease is dangerous.
