Hello! I have been a doctor for 21 years. My name is Georgy Olegovich Sapego. In this article I will talk about the anemia of chronic diseases.
They used to think that such anemia is associated with infection, inflammation and neoplasms, but then they decided that anemia in chronic renal failure, severe trauma, diabetes mellitus and in old of people. This is usually mild but noticeable anemia.
With such anemia, our bone marrow makes fewer red blood cells (erythrocytes), and those erythrocytes that still managed to escape from the bone marrow live less in the blood.
Several different mechanisms are at the heart of this outrage:
- Iron will be poorly absorbed from the intestines. There will be less of it in the blood than usual.
- In response to the death of erythrocytes in the blood, the synthesis of new cells is not started. Well, that is, the body is semaphoric and requires new blood from the bone marrow, but bone marrow for some reason kills young erythrocytes and does not release them anywhere.
- Decreased production of erythropoietin. Erythropoietin is our internal stimulant that causes the bone marrow to make red blood cells.
- Red blood cells for anemia of chronic diseases live a little. It is not clear exactly why this is happening. It is suspected that it is the immune cells. In chronic diseases, these cells are constantly on alert and under the hot hand can nail some of their own erythrocytes.
In general, interesting things happen with immunity there. All this internal war of ours, when the body spoils something for itself, it occurs under the influence of signaling compounds called cytokines.
There are now many new drugs available to treat rheumatoid arthritis and other annoying autoimmune diseases. These new drugs act on cytokines. At some point, they began to notice that together with arthritis, it was possible to cure anemia. Especially clearly these things were noticed in children with arthritis. In childhood, in general, everything is very noticeable and quickly manifests itself.
Nobody experimented on children, but scientists took laboratory animals and launched the very inflammatory cytokines into their blood. The animals got a real anemia of chronic diseases.
Hepcidin
Readers remembered about hepcidin, so I will not be shy and tell you about its meaning. Hepcidin is a simple protein that consists of several tens of amino acids. He is involved in the fight against infection.
In the last article about infection and iron, I told that our body hides iron from microbes. So hepcidin is responsible for this process. It prevents the iron from being absorbed from the intestines into the blood. It does not allow the gland to escape from the cells. It removes free iron from the blood. Cleans it out so that no germs get a drop.
All these mechanisms were also tested in laboratory conditions. Soup from killed microbes was injected into the blood of experimental mice and watched as hepcidin rises and begins to hide iron.
Now comes the fun part. Hepcidin has not yet been made the standard test for anemia. That is, if you go to the laboratory, then you will be tested for your money. But this will not make much sense, because the technique is not yet standard-ti-zo-va-na. It's too early to do this. You need to wait and sort it out normally.
How does it happen
Usually, a person has some kind of disease and mild anemia is found against its background. The symptoms are more likely to be associated with the same chronic disease. Anemia will not bother you much. People will be sick of a chronic disease anyway, so they will lie and will not run. So they won't even notice their slight anemia. It is understandable. The body did not hide the iron so that people began to swallow it again in tablets.
Analyzes
Hemoglobin will be somewhere around 100 - 110 g / l. That is, it is quite tolerable.
Blood levels of iron and transferrin will be low (transferrin is a protein that carries iron). Transferrin iron saturation will be normal or low.
This is how the anemia of chronic disease differs from iron deficiency anemia. With iron deficiency anemia, the body would be glad to pick up iron with transferrin, but there is little iron. Therefore, in case of iron deficiency anemia, on the contrary, a lot of iron-hungry transferrin floats in the blood, but its saturation with iron is specifically low. Because there is no iron. Complicated? That's not my fault! Readers have guessed these questions to me in the comments in the article on infection and iron.
Everyone's favorite ferritin is a bad helper here. He is tested in almost every laboratory on every corner, but with a chronic illness he lies. Because ferritin is referred to as the so-called acute phase indicators. That is, against the background of the disease, he crawls out for everyone.
Diagnosis
Now the funniest part. There is no exact analysis for this type of anemia. You can only notice many different suspicious gestures that make you suspect. Therefore, first go to the doctor, and only then to the laboratory. Maybe this:
- low levels of iron in the blood;
- normal or low blood transferrin;
- low saturation of transferrin with iron;
- normal or increased ferritin;
- high ESR or C-reactive protein (a sign of inflammation);
- high levels of hepcidin in the blood.
To treat or not to treat
Doctors openly say that the anemia of chronic diseases can be of some benefit to the body. I don't believe I wrote this. Well, that is, in the case of iron deficiency anemia, I am constantly at war with young patients who are trying to become donors or do some other stupid thing. But in the history of the anemia of a chronic illness, I would not so persistently feed people with iron.
We have not yet sorted out the stories about specific iron poisoning. It's even more fun there. So go to your doctor and ask him each time for each specific situation. There is such an anemia of a chronic disease that you can die. Then the patient will receive blood transfusions and all that. Therefore, do not self-medicate. The doctor will treat the underlying chronic disease, and then we'll see.
If you liked the article, then like it and subscribe to my channel. Check out my articles on related topics:
Don't feed your germs with iron
Many types of anemias
