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First Aid labels it under normocytic anemia, whereas Rapid Review Goljan labels it under microcytic anemia. :confused:

What do you guys think?
 

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Anemia of Chronic Disease in USMLE

Anemia of chronic disease can be normocytic, microcytic, and even macrocytic!
Anemia of chronic disease is a debatable issue in medicine. It's an umbrella that covers a variety of etiologies and pathogenic mechanisms.
Diseases that affect RBC production or elimination or survival directly are generally not labeled in this category, however such a disease indeed can be chronic, for example sickle cell disease.
On the other hand, diseases that primarily affect other body systems and yet they do cause anemia then these are what were commonly labeled to cause anemia of chronic disease. For example Rheumatoid arthritis (microcytic), kidney disease (normocytic), Liver disease (macrocytic).
This last category has several different mechanisms that result in anemia. Examples of these are; autoimmune, iron metabolism defect, infection, chronic inflammation cytokines, erythropoietin production, ....etc.
Furthermore, the same disease itself can cause anemia by two different mechanisms. For example Colon cancer can cause blood loss (microcytic) and chronic cytokine stimulation (normocytic).

Therefore, the designation of "Anemia of Chronic Disease" has become less distinct in modern textbooks and it's not a single identifiable disease process that we can talk about any more.

Whenever there's a vague debatable issue in medicine, the USMLE tends to steer away from it. They will never give you a patient and ask you to decide what type of anemia he/she has based on RBC size alone.

However, you may wanna take care of an important differentiator here which is serum ferritin. Serum ferritin being an inflammatory marker it's usually raised in chronic inflammations while it's low in Iron deficiency anemia.
 

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...Furthermore, the same disease itself can cause anemia by two different mechanisms. For example Colon cancer can cause blood loss (microcytic) and chronic cytokine stimulation (normocytic)...
anemia of chronic disease: 1. microcytic anemia: chronic cytokine stimulation 2. blood loss: normocytic anemia. could you please answer this query? thank you.
 

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anemia of chronic disease: 1. microcytic anemia: chronic cytokine stimulation 2. blood loss: normocytic anemia. could you please answer this qyery? thank you.
Blood loss causes normocytic anemia acutely as you have several reticulocytes with large diameter which increases the MCV back to normal range. But in the long run, when you have mild chronic blood loss as in colonic cancer or heavy menstruation then it's Iron deficiency anemia which is microcytic.
Chronic inflammation causes cytokines release that affect erythopoeitin release and some other effects, it tends to cause normocytic anemia. This is the prototype of chronic disease anemia classically mentioned in textbooks and that's why there's a tendency nowadays to be called anemia of chronic inflammation rather than anemia of chronic disease.

Did I answer your query!
 

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What Goljan said about anemia of chronic disease

I remember Goljan lecture when he said that during infections you have bugs in your body. These bugs love Iron. So the body shuts off the Iron from them by keeping it in macrophages.
Good news you won't lose Iron. Bad news you won't use your Iron. Therefore in anemia of chronic disease you have increased ferritin yet low hemoglobin level.
 

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Anemia of chronic disease

Key Points (Ref: BRS Pathology):

1- Anemia of chronic disease is often normochromic normocytic.

2- When associated with Renal disease, it may be moderately macrocytic.

3- When associated with chronic inflammatory states (i.e. RA), it may be accompanied by decreased serum iron and hypochromia and microcytosis. However, in this condition TIBC is characteristically low.

:):):):)
 
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