Anemia due to misuse of iron . This anemia is the second cause in order of frequency of anemia, after iron deficiency. Generally it is a normocytic and normochromic anemia, but sometimes it can be microcytic and hypochromic, thus establishing the need for differential diagnosis with iron deficiency anemia.
Summary
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- 1 Pathogenesis
- 2 Diagnosis
- 3 Study a patient with hypochromic microcytic anemia
- 4 Treatment
- 5 Source
Pathogeny
One of the mechanisms by which anemia occurs in chronic diseases is a decrease in the use of iron by deposit macrophages, which does not pass into plasma or the precursors of the red series, resulting in a decrease of plasma iron (hyposideremia) and a lack of use of iron by erythroid precursors.
Other complementary mechanisms to anemia in these diseases would be a decrease in the half-life of the red blood cell and an inadequate response of the bone marrow, as a consequence of a decrease in erythropoiesis due to the action of substances produced in situations of chronic diseases, such as interferon and tumor necrosis factor.
Diagnosis
As in iron deficiency, in anemia of chronic disease there is hyposideremia. Unlike the iron deficiency situation, there is a decrease in the transferrin concentration and a transferrin saturation that can be normal or decreased.
If we did a bone marrow study , we would find an increase in deposit iron. This can also be evidenced by the determination of serum ferritin, which is increased, unlike iron deficiency.
Study a patient with hypochromic microcytic anemia
It should be borne in mind that the two most frequent causes of this type of anemia are, firstly, iron deficiency, and secondly, anemia of chronic disease.
Among the parameters of the hemogram itself, an elevation of the HDI is suggestive of iron deficiency . Laboratory tests, such as sideremia , transferrin, and ferritin , should then be ordered . The decrease in serum iron does not serve, as we have just seen, to differentiate both processes.
An elevated transferrin and a decreased ferritin suggests iron deficiency. An unexpanded transferrin and increased serum ferritin suggests anemia of chronic disease.
In the last case, the study of the bone marrow would serve to differentiate both processes (deposited iron increased in anemia of chronic disease and decreased in iron deficiency).
Treatment
It must be that of the associated disease (inflammatory processes, chronic infections, tumor processes).
Despite hyposideremia , iron should not be administered in this disease , since the problem does not lie in the absence of iron, but in its misuse.
