Anemia of chronic diseases (it is also called inflammation anemia) is a common type of pathology that develops in patients suffering from one or another infectious, inflammatory or tumor disease. A distinctive feature of such anemia is a decrease in serum iron, but, in contrast to the true lack of iron, this trace element can persist in macrophages.
Description of the disease
Anemia of chronic diseases is currently the most common problem. This type of ailment takes the second place after 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 diseases (ACP) is determined by an infectious process that is associated with microbial pathogens (bacterial, viral or fungal 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 low gradation, for example, cancer, chronic kidney disease, heart failure and the like. In addition, a similar pathogenesis of anemia of chronic diseases during aging is noted, against which the 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 the ACP.
The difficulty for doctors 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 index, but with increased ferritin. It is worth noting that the treatment of such anemia with iron preparations does not lead to compensation for erythropoiesis. The use of modern diagnostic studies can improve and accelerate the diagnosis of anemia.
Given that anemia of chronic diseases is a secondary manifestation of the underlying disease, therapy of the latter also corrects anemia. True, such therapy is not always possible. A modern trend in medicine is the study of molecules of new drugs, whose target is the main pathogenetic links of chronic diseases, especially cytokines, along with correctors of the ferroportin branch. But most of the drugs are still at the stage of experimental research.
Anemia of chronic disease - blood picture
The blood picture with the described disease is observed as follows:
- The rate of serum iron is reduced.
- If the patient has anemia of chronic diseases, the iron-binding ability 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 ailments from iron deficiency disease.
- With this diagnosis, serum transferrin saturation, as a rule, is normal. A value above ten percent indicates a decrease in iron. A figure of less than ten percent indicates 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.
- Against the background of this disease, serum ferritin is usually normal or increases, in contrast to iron deficiency.
- In the presence of rheumatoid arthritis, liver disease, or against neoplasms, the normal value of serum ferritin does not exclude a concomitant iron deficiency. True, a ferritin level of less than 40 nanograms per milliliter indicates a significant decrease in iron stores in the body.
- An indicator such as free erythrocyte porphyrin, in the presence of anemia of chronic pathologies will be increased.
Symptomatology
Anemia of chronic pathologies, due to its slow development and mild course, as a rule, gives practically no symptoms. Any manifestations are usually related to those ailments against which or because of which anemia occurs in the body.
So, the symptoms that are characteristic of developing anemia include the presence in patients of increased fatigue of the body along with its general weakness and a sharp decrease in working capacity. In addition, obvious irritability with frequent dizziness, drowsiness, tinnitus, flies in front of the eyes, rapid heartbeat and shortness of breath during exercise or even at rest should be considered a characteristic symptomatology.
Thus, in the event of such symptoms, it is worth starting to sound 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 how dangerous this pathology is.
Pathology diagnostics
Anemia has certain common symptoms. Usually this is the presence of normocytic anemia of mild severity, when hemoglobin is kept in the region of more than 90 grams per liter. Such anemia develops during the first two months in the presence of infections, inflammatory pathology or against a background of malignant formation, while it does not progress. With a hemoglobin index below 80 grams per liter, you should consider 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 ailment, against the background of which iron deficiency develops in the body. But, nevertheless, in the event that anemia occurs, then patients are required to undergo 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 bleeding.
Patient Complaints
When collecting complaints from patients, as a rule, they determine the presence of the following symptoms in a patient:
- Palpitations and shortness of breath, aggravated by physical exertion.
- Dizziness and tinnitus.
- Weakness and fatigue.
How is anemia of a chronic disease treated (according to ICD-10, by the way, the ailment code is D63.8)?
Treatment
Given that anemia of chronic diseases is a secondary manifestation of the underlying disease, therapy of the latter will correct iron deficiency. However, such therapy is not always possible. The following items are referred to the principles of management of patients with anemia of chronic pathologies:
- The treatment of the underlying disease.
- The use of specific treatments for anemia. Such are prescribed only in the presence of a severe degree of the disease, which limits the ability to work along with the daily activity of the patient.
- With the development of severe anemia, a transfusion of red blood cells is prescribed.
- The appointment of erythropoiesis stimulating drugs with a combination with intravenous iron medications.
- Treatment methods may additionally include various erythropoiesis-stimulating innovative drugs along with anticytokine drugs and drugs that affect hepcidin and ferroportin.
It is worth noting that pathology does not appear as a registered indication for the appointment of erythropoiesis-stimulating drugs to patients, however, these can be considered as an alternative treatment for replacing multiple red blood cell transfusions. Some studies have reported positive results from the use of erythropoiesis-stimulating agents in the treatment of anemia of chronic diseases.
With heart failure
Among patients with chronic heart failure, the prevalence of anemia is thirty-seven percent. Among this number, more than half of patients report anemia of chronic diseases. In general, 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 the age differences of patients.
Normocytic anemia
At present, it has been proven that in patients with heart failure, normocytic anemia is more often detected, which accounts for up to fifty-seven percent of cases. Most often, this disease is associated with renal dysfunction and decreased 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 contributes, as a rule, to the occurrence of iron deficiency in the blood. It has now been proven that the main causes of anemia in patients with heart failure are hemodilution along with chronic kidney disease and vitamin B12 deficiency.
Clinical recommendations for anemia of chronic diseases
These include all methods for the prevention of chronic ailments and 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 number of this trace element, so necessary for the body. In this regard, it should be noted that in particular iron is found in red varieties of meat, for example, in beef. Do not forget about fruits, for example, apples, pomegranates, and so on should be preferred.
Everyone knows that movement along with walking is an excellent preventive measure in the presence of any disease. In this regard, to prevent the symptoms of unpleasant anemia it is extremely important to regularly maintain your body in good shape. Classes of moderate physical activity in the form of fitness, aerobics, swimming and skiing, significantly improve blood circulation, contributing to overall well-being.
Walks in the open air
Among other things, we must not forget that any anemia is primarily a lack of oxygen. Therefore, the best prevention of anemia is considered to be the possibility of replenishment of oxygen reserves in the body. For this, doctors advise walking a lot in the fresh air. Unfortunately, currently most people have sedentary work, many are constantly in a stuffy room, and all this will certainly affect the health of the body and is reflected in it not in the best way.
Conclusion
All of the above recommendations are quite effective in the presence of iron deficiency of any variety and with anemia of chronic diseases, including. 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 drugs for prophylaxis, but it’s worth noting right away that you still should not abuse them. Therefore, it is best to prevent a disease that can cause iron deficiency in the body through the banal maintenance of a healthy lifestyle.
We found out what anemia is and how dangerous this disease is.