Anemia of chronic disease laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Laboratory Findings
- 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) aand acute phase reactants (eg, fibrinogen, erythrocyte sedimentation rate, C-reactive protein, ferritin, haptoglobin, factor VIII)
Iron studies
- Low serum iron concentration and transferrin level (also measured as total iron binding capacity, TIBC)
- Normal or low-normal percent saturation of transferrin (TSAT)
- Normal or elevated serum ferritin concentration
Soluble transferrin receptor [5][5][6][7]
sTfR is normal in patients with ACD. It helps to distinguish between IDA and ACD [83-86].
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
- ↑ 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.
- ↑ Weiss G, Goodnough LT (March 2005). "Anemia of chronic disease". N. Engl. J. Med. 352 (10): 1011–23. doi:10.1056/NEJMra041809. PMID 15758012.
- ↑ 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.
- ↑ 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.
- ↑ 5.0 5.1 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.
- ↑ 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.
- ↑ 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.