Main Pathophysiological, Diagnostic and Therapeutic Aspects in Anemia of Chronic Inflammation

Main Pathophysiological, Diagnostic and Therapeutic Aspects in Anemia of Chronic Inflammation

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Submitted Nov 30, 2021
Published Mar 29, 2022
DOI https://doi.org/10.24018/clinicmed.2022.3.2.157
Abstract viewed = 148 times
Issue
Vol. 3 No. 2 (2022)
Section
Review

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  •   Guido D'Angelo

    •    Hematology and Microbiology-Gallarate Hospital, Italy

Abstract

In chronic inflammation, iron deficiency over time causes a developmental clinical condition ranging from non-anemia to evident microcytic and hypochromic anemia. Pathophysiologically, the iron imbalance in chronic inflammation is mediated by the increase in hepcidin. Its dosage, not yet used routinely, represent an important diagnostic parameter in the setting of anemia, particularly in Anemia of Chronic Deficiency or in the Anemia of Chronic Deficiency/Iron Deficiency Anemia combination. Immunologically, B and T lymphocytes for their activation process need iron to proliferate; in infections, the interaction of myeloid cells, T and B cells, results in inflammatory cytokines secretion which modify iron homeostasis. In chronic inflammation, the rational approach to restore the proper iron flow from the cell to the blood, is to treat the underlying disease, at the same time, adequate iron therapy should be considered. The diagnosis, as well as the correct therapeutic approach to anemia of chronic disease are both increasingly a challenge.


Keywords: Anemia, chronic inflammation, diagnosis, hepcidin, iron therapy

References

Benoist B, McLean E, Egli I, Cogswell M. eds. Worldwide, Prevalence of anaemia 1993 - 2005. WHO Global Database on Anaemia Geneva, World Health Organization, 2008.

Weiss G. Pathogenesis and treatment of anemia of chronic disease. Blood Reviews. 2002; 16: 87-96.

Weiss G, Goodnough LT. Anemia of chronic disease. New England Journal of Medicine. 2005; 352: 1011-1023.

Means RT Jr. Recent developments in the anemia of chronic disease. Current Hematology Reports. 2003; 2: 116-121.

Nemeth E, Ganz T. Regulation of iron metabolism by hepcidin. Annual Reviews of Nutrition. 2006; 26: 323-42.

Wallace DF. The Regulation of iron absorption and homeostasis. Clinical Biochemist Reviews. 2016; 37: 51-62.

Liu Q, Davidoff O, Niss K, Haase VH. Hypoxia-inducible factor regulates hepcidin via erythropoietin-induced erythropoiesis. Journal of Clinical Investigation. 2012; 122: 4635-4644.

Musci G, Polticelli F, Bonaccorsi di Patti MC. Ceruloplasmin-ferroportin system of iron traffic in vertebrates. World Journal of Biological Chemistry. 2014; 26(5): 204-215

Quiles del Rey M, Mancias JD. NCOA4-mediated ferritinophagy: A potential link to neurodegeneration. Frontiers of Neuroscience. 2019; 13: 238.

Kautz L, Jung G, Valore EV, Rivella S, Nemeth E, Ganz T. Identification of erythroferrone as an erythroid regulator of iron metabolism. Nature Genetics. 2014; 46: 678- 684.

Kelly AU, McSorley ST, Patel P, Talwar D. Interpreting iron studies. BMJ. 2017; 357: j2513.

De Block CEM, Van Capenhout CM, De Leeuw IH, Keenoy BM, Martin M, Van Hoof V, et al. Soluble transferrin receptor level: a new marker of iron deficiency anemia, a common manifestation of gastric autoimmunity in type 1 diabetes. Diabetes Care. 2000; 23: 1384-1388.

Shin DH, Kim HS, Park MJ, Suh IB, Shin KS. Utility of access soluble transferrin receptor (sTfR) and sTfR/log ferritin Index in diagnosing iron deficiency anemia. Annals of Clinical Laboratory Science. 2015; 45: 396-402.

Camaschella C. Iron deficiency. Blood. 2019;133: 30-39.

Dharwadkar A, Vimal S, Panicker NK, Chandanwale SS, Viswanathan V, Kumar H. Study of sideroblasts and iron stores in bone marrow aspirates using Perls’ stain. Med J DY Patil University. 2016; 9: 181-185.

Schultz DR, Arnold PI. Properties of four acute phase proteins: C-reactive protein, serum amyloid A protein, alpha 1-acid glycoprotein, and fibrinogen. Semin Arthritis Rheum. 1990; 20: 129-147.

Costenbader KH, Chibnik LB, Schur PH. Discordance between erythrocyte sedimentation rate and C-reactive protein measurements: clinical significance. Clinical and Experimental Rheumatology. 2007; 25: 746-749.

Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron-deficiency anemia: an overview. Journal of General Internal Medicine. 1992; 7: 145-153.

Finch CA, Bellotti V, Stray S, Huebers HA, Bellotti V, Lipschitz DA, et al. Plasma ferritin determination as a diagnostic tool. Western Journal of Medicine. 1986; 145: 657-663.

McSorley ST, Tham A, Jones I, Talwar D, McMillan DC. Regression correction equation to adjust serum iron and ferritin concentrations based on C-reactive protein and albumin in patients receiving primary and secondary care. Journal of Nutrition. 2019; 149: 877-883.

WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.2). Available from: http://www.who.int/vmnis/indicators/serum_ferritin. pdf, accessed.

Kemna EHJM, Tjalsma H, Willems HL, Swinkels DW. Hepcidin: from discovery to differential diagnosis. Haematologica. 2008; 93: 90-97.

Nemeth E, Tuttle MS, Powelson J, Vaughn MB, Donovan A, Ward DM, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science. 2004; 306(5704): 2090-2093.

D’Angelo G. Role of hepcidin in the pathophysiology and diagnosis of anemia. Blood Research. 2013; 48: 10-15.

Camaschella C, Nai A, Silvestri L. Iron metabolism and iron disorders revisited in the hepcidin era. Haematologica. 2020; 105: 260-272.

Nairz M, Weiss G. Iron in infection and immunity. Molecular Aspects of Medicine. 2020; 75: 100864.

Drakesmith H, Pasricha SR, Cabantchik I, Hershko C, Weiss G, Girelli D, et al. Vaccine efficacy and iron deficiency: an intertwined pair? Viewpoint. Lancet Hematology. 2021; 8: e666 - e669.

Shah A, Frost JN, Aaron L, Donovan K, Drakesmith H, Collaborators. Systemic hypoferremia and severity of hypoxemic respiratory failure in COVID-19. Critical Care. 2020; 24: 320-323.

Fertrin HY. Diagnosis and management of iron deficiency in chronic inflammatory conditions (CIC): is too little iron making your patient sick? Hematology ASH Education Program. 2020: 478-486.

Nairz M, Theurl I, Wolf D, Weiss G. Iron deficiency or anemia of inflammation? Wiener Medizinische Wochenschrift. 2016; 166: 411-423.

Casu C, Nemeth E, Rivella S. Hepcidin agonists as therapeutic tools. Blood. 2018; 131: 1790-1794.

Poli M, Asperti M, Ruzzenenti P, Regoni M, Arosio P. Hepcidin antagonists for potential treatments of disorders with hepcidin excess. Frontiers of Pharmacology. 2014; 5: 86.

Wicinski M, Liczner G, Cadelski K, Kołnierzak T, Nowaczewska M, Malinowski B. Anemia of chronic diseases: wider diagnostics - better treatment? Nutrients. 2020; 12: 1784-1801.

Gelaw Y, Woldu B, Melku M. The role of reticulocyte hemoglobin content for diagnosis of iron deficiency and iron deficiency anemia and monitoring of iron therapy: a literature review. Clinical Laboratory. 2019; 65(12).

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How to Cite
D’Angelo, G. (2022). Main Pathophysiological, Diagnostic and Therapeutic Aspects in Anemia of Chronic Inflammation. European Journal of Clinical Medicine, 3(2), 1–5. https://doi.org/10.24018/clinicmed.2022.3.2.157