Pediatr. praxi. 2007;8(5):276-280
ANAEMIA OF CHRONIC DISEASES IN THE LIGHT OF NEW FINDINGS
- Dětská klinika LF UP a FN Olomouc
Anaemia of chronic diseases (ACD) is the second most common type of anaemia in the population and the most common type of anaemia in hospitalized patients with chronic diseases. It accompanies four groups of diseases: acute and chronic infections, inflammatory non-infectious diseases, autoimmune diseases and malignancies. It can substantially influence the quality of life of ill children.
In the disease pathogenesis, four etiopathogenetic mechanisms play a role: changes in iron homeostasis, decreased proliferation of erythroid progenitor cells, decreased erythropoietin production and shortened erythrocyte life span. All of these are caused by increased cytokine production (IL-1, IL-6, INF-α, β, γ, TNF- α) and by the activation of the cells of the reticuloendothelial system. Additional complicating factors specific for underlying diseases can influence the character of anaemia (chronic bleeding in inflammatory bowel diseases, immunosupressive drugs effects in collagen vascular diseases, severely decreased EPO production in renal failure, haemolysis due to autoantibodies production etc.). A hallmark of ACD are changes in iron homeostasis caused by inflammation. Increased cytokine production induces changes in the expression of genes that code proteins essential for iron balance: ferroportin, DMT1 protein, hepcidin. This leads to abnormal iron distribution with a decrease of serum iron and the accumulation of iron in macrophages and enterocytes. Diagnosis of ACD is complicated and requires several haematological and biochemical laboratory test. In differential diagnosis, it is very important to exclude iron deficiency anaemia and thalassaemia. The basic condition of the successful treatment of ACD is the targeted therapy of the underlying disease. In severe anaemia, transfusion is usually indicated. Other treatment possibilities include erythropoietin and intravenous iron in cases of ACD with absolute iron deficiency. Diagnosis and treatment of this condition in children requires an interdisciplinary approach.
Keywords: anaemia, iron metabolism, cytokines, macrophages, ferroportin, hepcidin, DMT1 protein, iron deficiency, erythropoietin
Published: December 1, 2007 Show citation
