ANEMIA OF CHRONIC

DISORDERS (ACD)

Mulyadi

Bagian
Patologi
Klinik Fakultas
Department
of Clinical
Pathology,Kedokteran
Faculty of
Medicine,
Universitas
Bengkulu
University of Indonesia

IRON

PROTOPORPHYRIN

a. Iron deficiency
b. Chronic inflammation/
malignancy

Sideroblastic anemia

Haem

Globin

Thalassemia
( or )
Haemoglobin

ANEMIA OF CHRONIC DISORDERS

(ACD)
One of the most common anemia occur in
patients:
Chronic inflammatory
Chronic infection
Trauma
Malignancy
Renal, hepatic and edocrinologic diseases are not
consistently associated with abnormalities of iron
metabolism seen in ACD

PATHOGENESIS
Anemia related to decreased release of iron from
macrophage to plasma
Reduced RBC lifespan
In adequate it erythropoietin response to anemia, cause
by effects of cytokine such IL-1, TNF on erythropoiesis
Hepcidin released by the liver in response to inflammation

Inhibits macrophage
release of iron

Inhibits iron
absorption

CAUSES OF THE ANEMIA OF CHRONIC

DISORDERS
Chronic inflammatory diseases
Infections (e.g. pulmonary abscess, tuberculosis,
osteomyelitis, pneumonia, bacterial endocarditis)
Non-infections (e.g. rheumatoid arthritis,
systemic lupus erythematosus and other
connective tissue disease, sarcoidosis, Crohns
disease
Malignant diseases
Carcinoma, lymphoma, sarcoma
Hoffbrand AV, Moss PAH, Pettit JE. Essential haematology .5th ed. Oxford : Blackwell Publishing; 2006.p.39.

INVESTIGATION OF A HYPOCHROMIC
MICROCYTIC ANAEMIA
MCV / MCH

BLOOD FILM
SERUM IRON

SERUM IRON

MARROW FOR IRON

SIDEROBLASTIC
ANAEMIA

SERUM IRON N /

SERUM IRON

HAEMOGLOBIN
STUDIES : Hb F/
HbA2

FERRITIN LEVEL

THALASSAEMIA,
ABNORMAL
HAEMOGLOBIN

Ferritin

Ferritin N /

IRON
DEFICIENCY

ANAEMIA OF
CHRONIC DISORDER

Lewis SM, Bain BJ, Bates I. Dacie and Lewis practical haematology. 9 th ed. London : Churchill Livingstone; 2001.p.582.

LABORATORY FINDINGS
Hypoferremia
Normochromic normocytic anemia, rarely
hypochromic microtic anemia
Serum iron , TIBC , saturation index <15%
BM iron stores normal or , serum ferritin
normal or
Reduced BM sideroblastic iron because
reduced supply of iron to the marrow
erythrocyte

Laboratory findings

Abnormal plasma protein acute phase response

IL-1 + other mediators of inflammation
(Protein synthesis)
Macrophage

Complement
Ferritin
Phagocytic
activity

Hepatocyte
Acute-phase
reactans
Albumin
Transferrin (TIBC)

CRP
IL-1 sedimentation rate
Erythrocyte
(ESR) increased

LABORATORY DIAGNOSIS OF
HYPOCHROMIC ANAEMIA
Iron deficiency

Chronic inflammatory
or malignancy

MCV
MCH

Reduced in relation to
severity of anaemia

Normal or mild reduction

Serum iron

Reduced

Reduced

TIBC

Raised

Reduced

Serum transferrin Raised

receptor
Serum ferritin
Reduced

Normal/low

Bone marrow iron

stores

Absent

Present

Erythroblast iron

Absent

Absent

Normal or raised

Hoffbrand AV, Moss PAH, Pettit JE. Essential haematology .5th ed. Oxford : Blackwell Publishing; 2006.p.39.

TREATMENT
Iron therapy and hematinic agent are
unnecessary
Resolve the underlying inflammatory or
infectious process successfully treated
Anemia will improve with effective
chemotherapy for malignant disease
The anemia response to erythropoietin in
ACD