Anemia of chronic disease laboratory findings: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(9 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Anemia of chronic disease}}
{{Anemia of chronic disease}}
{{CMG}}
{{CMG}}{{shyam}}{{AE}}{{OK}}
==Overview==
==Overview==
Mild [[Normocytic anemia|normocytic]] and [[Normochromic anemia|normochromic]] [[anemia]] with a [[hemoglobin]] concentration of 10 to 11 g/dL. Less than 25 percent of the cases have [[microcytic]] and [[hypochromic anemia]] with a [[mean corpuscular volume]] (MCV) less than 70 fL. Normal or low [[mean corpuscular hemoglobin]] (MHC) similar to the MCV, and normal to increased red cell distribution width (RDW). No significant changes in the [[mean corpuscular hemoglobin concentration]] (MCHC). 20 percent of cases have severe [[anemia]], with a [[hemoglobin]] concentration <8 g/dL. [[Absolute reticulocyte count]] is frequently low (<25,000/microL). There could be an elevation in [[cytokines]] (eg, [[IL-6]], [[interferon-gamma]]) and acute phase reactants (e.g. [[fibrinogen]], [[erythrocyte sedimentation rate]], [[C-reactive protein]], [[ferritin]], [[haptoglobin]], [[factor VIII]]).
.
==Laboratory Findings==
==Laboratory Findings==
'''General''' <ref name="pmid23953340">{{cite journal |vauthors=Gangat N, Wolanskyj AP |title=Anemia of chronic disease |journal=Semin. Hematol. |volume=50 |issue=3 |pages=232–8 |date=July 2013 |pmid=23953340 |doi=10.1053/j.seminhematol.2013.06.006 |url=}}</ref><ref name="pmid15758012">{{cite journal |vauthors=Weiss G, Goodnough LT |title=Anemia of chronic disease |journal=N. Engl. J. Med. |volume=352 |issue=10 |pages=1011–23 |date=March 2005 |pmid=15758012 |doi=10.1056/NEJMra041809 |url=}}</ref><ref name="pmid2392639">{{cite journal |vauthors=Vreugdenhil G, Löwenberg B, van Eijk HG, Swaak AJ |title=Anaemia of chronic disease in rheumatoid arthritis. Raised serum interleukin-6 (IL-6) levels and effects of IL-6 and anti-IL-6 on in vitro erythropoiesis |journal=Rheumatol. Int. |volume=10 |issue=3 |pages=127–30 |date=1990 |pmid=2392639 |doi= |url=}}</ref><ref name="pmid15774616">{{cite journal |vauthors=Macciò A, Madeddu C, Massa D, Mudu MC, Lusso MR, Gramignano G, Serpe R, Melis GB, Mantovani G |title=Hemoglobin levels correlate with interleukin-6 levels in patients with advanced untreated epithelial ovarian cancer: role of inflammation in cancer-related anemia |journal=Blood |volume=106 |issue=1 |pages=362–7 |date=July 2005 |pmid=15774616 |doi=10.1182/blood-2005-01-0160 |url=}}</ref>
'''General''' <ref name="pmid23953340">{{cite journal |vauthors=Gangat N, Wolanskyj AP |title=Anemia of chronic disease |journal=Semin. Hematol. |volume=50 |issue=3 |pages=232–8 |date=July 2013 |pmid=23953340 |doi=10.1053/j.seminhematol.2013.06.006 |url=}}</ref><ref name="pmid15758012">{{cite journal |vauthors=Weiss G, Goodnough LT |title=Anemia of chronic disease |journal=N. Engl. J. Med. |volume=352 |issue=10 |pages=1011–23 |date=March 2005 |pmid=15758012 |doi=10.1056/NEJMra041809 |url=}}</ref><ref name="pmid2392639">{{cite journal |vauthors=Vreugdenhil G, Löwenberg B, van Eijk HG, Swaak AJ |title=Anaemia of chronic disease in rheumatoid arthritis. Raised serum interleukin-6 (IL-6) levels and effects of IL-6 and anti-IL-6 on in vitro erythropoiesis |journal=Rheumatol. Int. |volume=10 |issue=3 |pages=127–30 |date=1990 |pmid=2392639 |doi= |url=}}</ref><ref name="pmid15774616">{{cite journal |vauthors=Macciò A, Madeddu C, Massa D, Mudu MC, Lusso MR, Gramignano G, Serpe R, Melis GB, Mantovani G |title=Hemoglobin levels correlate with interleukin-6 levels in patients with advanced untreated epithelial ovarian cancer: role of inflammation in cancer-related anemia |journal=Blood |volume=106 |issue=1 |pages=362–7 |date=July 2005 |pmid=15774616 |doi=10.1182/blood-2005-01-0160 |url=}}</ref>
 
* Mild [[Normocytic anemia|normocytic]] and [[normochromic anemia]] with a [[hemoglobin]] concentration of 10 to 11 g/dL
Mild normocytic and normochromic anemia
* [[Microcytic]] and [[hypochromic anemia]] with a [[mean corpuscular volume]] (MCV) less than 70 fL in less than 25 percent of the cases
 
* Normal or low [[mean corpuscular hemoglobin]] (MHC) similar to the MCV
Hemoglobin concentration of 10 to 11 g/dL.
* Normal to increased red cell distribution width (RDW)  
 
* No significant changes in the [[mean corpuscular hemoglobin concentration]] (MCHC)
Microcytic and hypochromic in less than 25 percent of the cases with a mean corpuscular volume (MCV) is rarely less than 70 fL [2,10}
* Severe [[anemia]], with a [[hemoglobin]] concentration <8 g/dL in 20 percent of cases
 
* Low absolute [[reticulocyte count]] (<25,000/microL) in many cases
The mean corpuscular hemoglobin (MHC) is normal or low  similar to the MCV, and the red cell distribution width (RDW) is normal to increased.
* Elevation in [[cytokines]] (e.g. [[IL-6]], [[interferon-gamma]])
 
* Elevation in acute phase reactants (e.g., [[fibrinogen]], [[erythrocyte sedimentation rate]], [[C-reactive protein]], [[ferritin]], [[haptoglobin]], [[factor VIII]])  
No significant changes in the mean corpuscular hemoglobin concentration (MCHC).
'''Iron studies'''
 
* Low serum [[iron]] concentration and [[transferrin]] level (also measured as [[Total iron-binding capacity|total iron binding capacity]], TIBC)  
Severe anemia, with a hemoglobin concentration <8 g/dL, occurs in approximately 20 percent of cases. The absolute reticulocyte count is frequently low (<25,000/microL)
* Normal or low-normal percent saturation of [[transferrin]] (TSAT)
 
* Normal or elevated serum [[ferritin]] concentration
Elevation in cytokines (eg, IL-6, interferon-gamma) as well as acute phase reactants (eg, fibrinogen, erythrocyte sedimentation rate, C-reactive protein, ferritin, haptoglobin, factor VIII) [81,82].
'''Soluble transferrin receptor''' studies<ref name="pmid10817554">{{cite journal |vauthors=Suominen P, Möttönen T, Rajamäki A, Irjala K |title=Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia |journal=Arthritis Rheum. |volume=43 |issue=5 |pages=1016–20 |date=May 2000 |pmid=10817554 |doi=10.1002/1529-0131(200005)43:5<1016::AID-ANR9>3.0.CO;2-3 |url=}}</ref><ref name="pmid19795030">{{cite journal |vauthors=Koulaouzidis A, Said E, Cottier R, Saeed AA |title=Soluble transferrin receptors and iron deficiency, a step beyond ferritin. A systematic review |journal=J Gastrointestin Liver Dis |volume=18 |issue=3 |pages=345–52 |date=September 2009 |pmid=19795030 |doi= |url=}}</ref><ref name="pmid23086764">{{cite journal |vauthors=Infusino I, Braga F, Dolci A, Panteghini M |title=Soluble transferrin receptor (sTfR) and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia. A meta-analysis |journal=Am. J. Clin. Pathol. |volume=138 |issue=5 |pages=642–9 |date=November 2012 |pmid=23086764 |doi=10.1309/AJCP16NTXZLZFAIB |url=}}</ref>
 
* sTfR is normal in patients with ACD.  
'''Iron studies''' — The serum iron concentration and transferrin level (also measured as total iron binding capacity, TIBC) are both low and the percent saturation of transferrin (TSAT) is usually normal or low-normal. The latter two findings help to distinguish ACD from iron deficiency anemia, in which the transferrin level is '''increased''' and TSAT is low (table 1).
* It helps to distinguish between [[Iron deficiency anemia]] and ACD
 
'''sTfR - ferritin index'''<ref name="pmid15758012">{{cite journal |vauthors=Weiss G, Goodnough LT |title=Anemia of chronic disease |journal=N. Engl. J. Med. |volume=352 |issue=10 |pages=1011–23 |date=March 2005 |pmid=15758012 |doi=10.1056/NEJMra041809 |url=}}</ref><ref name="pmid9028338">{{cite journal |vauthors=Punnonen K, Irjala K, Rajamäki A |title=Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency |journal=Blood |volume=89 |issue=3 |pages=1052–7 |date=February 1997 |pmid=9028338 |doi= |url=}}</ref>
However, approximately 20 percent of patients with ACD have a TSAT in the iron deficiency range (as low as 10 percent). In most patients, the effect of hepcidin to block the release of iron from macrophages is responsible for the low serum iron levels and low TSAT (figure 2 and figure 4). (See "Causes and diagnosis of iron deficiency and iron deficiency anemia in adults", section on 'Iron studies (list of available tests)'.)
* Calculation of the ratio of sTfR (expressed as mg/L) to [[ferritin]] (expressed as mcg/L), or the ratio of sTfR to the logarithm (to the base 10) of the [[ferritin]] concentration
 
* A sTfR/log [[ferritin]] ratio (TfR-[[ferritin]] index) <1 suggests the diagnosis of ACD, while a ratio >2 suggests the presence of IDA . Those with the combination of IDA and ACD will also have a TfR-[[ferritin]] index >2.
The serum ferritin concentration, which is usually normal or elevated in ACD, is a poor index of iron stores in chronic inflammatory diseases since ferritin is also an acute phase reactant (table 2). In addition, the destruction of hepatic or splenic tissue due to the primary disease may release relatively large amounts of ferritin into the circulation. (See "Acute phase reactants" and "Causes and diagnosis of iron deficiency and iron deficiency anemia in adults", section on 'Patients with inconclusive initial testing or comorbidities'.)
'''Peripheral blood smear'''
 
* [[Leukocytosis]] with a "[[left shift]]" (bands and immature forms) in the presence of [[infection]]
'''Soluble transferrin receptor''' — Measurement of the soluble transferrin receptor (sTfR; also called circulating transferrin receptor or serum transferrin receptor) provides a quantitative measure of total erythropoietic activity, since its concentration in serum is directly proportional to the erythropoietic rate and inversely proportional to tissue iron availability. Accordingly, sTfR is normal in patients with ACD, while it is increased in those with iron deficiency anemia (IDA). This subject is discussed in depth separately. (See "Causes and diagnosis of iron deficiency and iron deficiency anemia in adults", section on 'Diagnostic evaluation'.)
* Presence of [[leukemic]] or [[malignant]] cells, or [[leukopenia]]/[[lymphocytopenia]] in [[cancer]] or acute or chronic disorders involving the [[immune system]]
 
'''Bone marrow studies''' <ref name="pmid14175842">{{cite journal |vauthors=ELLIS LD, JENSEN WN, WESTERMAN MP |title=MARROW IRON. AN EVALUATION OF DEPLETED STORES IN A  SERIES OF 1,332 NEEDLE BIOPSIES |journal=Ann. Intern. Med. |volume=61 |issue= |pages=44–9 |date=July 1964 |pmid=14175842 |doi= |url=}}</ref>
The biologic principle is that in iron deficiency states, cellular membrane transferrin receptor density increases, with the result that truncated forms of sTfR appear in the serum in increased amounts. Measurement of sTfR can distinguish between IDA and ACD [83-86].
* Normal or increased amounts of storage [[iron]] in [[bone marrow]] [[macrophages]] 
 
* Decreased number of sideroblasts
'''sTfR - ferritin index''' — Calculation of the ratio of sTfR (expressed as mg/L) to ferritin (expressed as mcg/L), or the ratio of sTfR to the logarithm (to the base 10) of the ferritin concentration may also be useful for distinguishing between ACD and IDA (figure 5). (See "Causes and diagnosis of iron deficiency and iron deficiency anemia in adults", section on 'Diagnostic evaluation'.)
 
This ratio is effective in making this distinction since the numerator (sTfR) is increased in IDA and normal in ACD, while the denominator (ferritin or log ferritin) is decreased in IDA and normal to increased in ACD. Specifically, a sTfR/log ferritin ratio (TfR-ferritin index) <1 suggests the diagnosis of ACD, while a ratio >2 suggests the presence of IDA [10,87]. Those with the combination of IDA and ACD will also have a TfR-ferritin index >2.
 
'''Peripheral blood smear''' — The red cells in patients with ACD are normocytic and normochromic in over 75 percent of cases. Stigmata of the underlying disorder may be present on the peripheral smear, such as leukocytosis with a "left shift" in infection, the presence of leukemic or malignant cells, or leukopenia/lymphocytopenia in those with cancer or acute or chronic disorders involving the immune system. (See "Approach to the patient with neutrophilia" and "Evaluation of the peripheral blood smear", section on 'Worrisome findings' and "Approach to the child with lymphocytosis or lymphocytopenia", section on 'Lymphocytopenia'.)
 
'''Bone marrow studies''' — Examination of the bone marrow for its content and distribution of iron is instructive, although this examination is not performed routinely in patients with suspected ACD. In the most classical presentation of ACD, bone marrow macrophages contain normal or increased amounts of storage iron, reflecting reduced export of iron from macrophages due to the action of hepcidin. In addition, erythroid precursors show decreased or absent staining for iron (ie, decreased numbers of sideroblasts), reflecting reduced availability of iron for red cell production (picture 1) [88].


==References==
==References==

Latest revision as of 00:33, 24 November 2018

Anemia of chronic disease Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Anemia of chronic disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Anemia of chronic disease laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Anemia of chronic disease laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Anemia of chronic disease laboratory findings

CDC on Anemia of chronic disease laboratory findings

Anemia of chronic disease laboratory findings in the news

Blogs on Anemia of chronic disease laboratory findings

Directions to Hospitals Treating Anemia of chronic disease

Risk calculators and risk factors for Anemia of chronic disease laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Shyam Patel [2]Associate Editor(s)-in-Chief: Omer Kamal, M.D.[3]

Overview

Mild normocytic and normochromic anemia with a hemoglobin concentration of 10 to 11 g/dL. Less than 25 percent of the cases have microcytic and hypochromic anemia with a mean corpuscular volume (MCV) less than 70 fL. Normal or low mean corpuscular hemoglobin (MHC) similar to the MCV, and normal to increased red cell distribution width (RDW). No significant changes in the mean corpuscular hemoglobin concentration (MCHC). 20 percent of cases have severe anemia, with a hemoglobin concentration <8 g/dL. Absolute reticulocyte count is frequently low (<25,000/microL). There could be an elevation in cytokines (eg, IL-6, interferon-gamma) and acute phase reactants (e.g. fibrinogen, erythrocyte sedimentation rate, C-reactive protein, ferritin, haptoglobin, factor VIII). .

Laboratory Findings

General [1][2][3][4]

Iron studies

Soluble transferrin receptor studies[5][6][7]

sTfR - ferritin index[2][8]

  • Calculation of the ratio of sTfR (expressed as mg/L) to ferritin (expressed as mcg/L), or the ratio of sTfR to the logarithm (to the base 10) of the ferritin concentration
  • A sTfR/log ferritin ratio (TfR-ferritin index) <1 suggests the diagnosis of ACD, while a ratio >2 suggests the presence of IDA . Those with the combination of IDA and ACD will also have a TfR-ferritin index >2.

Peripheral blood smear

Bone marrow studies [9]

References

  1. ↑ Gangat N, Wolanskyj AP (July 2013). "Anemia of chronic disease". Semin. Hematol. 50 (3): 232–8. doi:10.1053/j.seminhematol.2013.06.006. PMID 23953340.
  2. ↑ 2.0 2.1 Weiss G, Goodnough LT (March 2005). "Anemia of chronic disease". N. Engl. J. Med. 352 (10): 1011–23. doi:10.1056/NEJMra041809. PMID 15758012.
  3. ↑ Vreugdenhil G, Löwenberg B, van Eijk HG, Swaak AJ (1990). "Anaemia of chronic disease in rheumatoid arthritis. Raised serum interleukin-6 (IL-6) levels and effects of IL-6 and anti-IL-6 on in vitro erythropoiesis". Rheumatol. Int. 10 (3): 127–30. PMID 2392639.
  4. ↑ Macciò A, Madeddu C, Massa D, Mudu MC, Lusso MR, Gramignano G, Serpe R, Melis GB, Mantovani G (July 2005). "Hemoglobin levels correlate with interleukin-6 levels in patients with advanced untreated epithelial ovarian cancer: role of inflammation in cancer-related anemia". Blood. 106 (1): 362–7. doi:10.1182/blood-2005-01-0160. PMID 15774616.
  5. ↑ Suominen P, Möttönen T, Rajamäki A, Irjala K (May 2000). "Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia". Arthritis Rheum. 43 (5): 1016–20. doi:10.1002/1529-0131(200005)43:5<1016::AID-ANR9>3.0.CO;2-3. PMID 10817554.
  6. ↑ Koulaouzidis A, Said E, Cottier R, Saeed AA (September 2009). "Soluble transferrin receptors and iron deficiency, a step beyond ferritin. A systematic review". J Gastrointestin Liver Dis. 18 (3): 345–52. PMID 19795030.
  7. ↑ Infusino I, Braga F, Dolci A, Panteghini M (November 2012). "Soluble transferrin receptor (sTfR) and sTfR/log ferritin index for the diagnosis of iron-deficiency anemia. A meta-analysis". Am. J. Clin. Pathol. 138 (5): 642–9. doi:10.1309/AJCP16NTXZLZFAIB. PMID 23086764.
  8. ↑ Punnonen K, Irjala K, Rajamäki A (February 1997). "Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency". Blood. 89 (3): 1052–7. PMID 9028338.
  9. ↑ ELLIS LD, JENSEN WN, WESTERMAN MP (July 1964). "MARROW IRON. AN EVALUATION OF DEPLETED STORES IN A SERIES OF 1,332 NEEDLE BIOPSIES". Ann. Intern. Med. 61: 44–9. PMID 14175842.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Anemia_of_chronic_disease_laboratory_findings&oldid=1504319"