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Anemia of Chronic Disease - Coggle Diagram
Anemia of Chronic Disease
Classification of Anemia
Morphological
Macrocytic anemia
Normocytic anemia
Microcytic hypochromic anemia
Pathophysiological
Decreased red cell production
Increased red cell production
Causes
Systemic diseases
non-hematological disorders
RBC disorders
hematological disorders
Pathophysiology
Inflammation → major cause
Decreased RBC lifespan
Impaired iron metabolism
Decreased iron release from RE stores
Decreased Epo levels
Suppressed erythropoiesis
Characteristics
Hyperproliferative anemia >>> mild anemia
Usually normochromic normocytic RBC → mild hypochromic microcytic anemia
Normal or low MCHC, MCV
Serum Fe decreased
TIBC decreased
%TS decreased
Iron stores in RE cells increased
Anemia associated w/ infection
Presence of inflammatory products
Hemorrhage caused by toxin and parasite invasion
Virus-induced autoimmune hemolytic anemia
Viral infection
HIV & AIDS
Direct destruction of CD4+ T lymphs
Direct infection of BM
Thrombocytopenia
Decreased RBC production / suppressed erythropoiesis
Anemia associated w/ inflammatory disorders
E.g.
Rheumatoid arthritis (RA)
Systemic lupus erythematosus (SLE)
Mixed connective tissue disease (MCTD)
Scleroderma
Dermatomyositis
Sjorgen’s syndrome
Pathophysiology
correlated w/ acute-phase reactants
Decreased serum Epo → RA
Serum inhibitor (auto-Abs) against myeloid & erythroid colony formation → SLE
Renal disease
Characteristics
Usually normochromic normocytic anemia
BM: plasmacytosis commonly seen
Treatment
rHuEpo treated to increase erythropoiesis → usually for RA
Anemia associated w/ cancer
multiple factors
Type of cancer
Site of cancer
Therapy
Involvement of BM
Pathophysiology
Direct effects
myelophthisic anemia
Leukoerythroblastosis
Indirect effects
Cancer causing chronic inflammatory response
Treatment
Chemotherapy
Radiation effect
ANEMIA ASSOCIATED W/ LIVER DISEASE
Pathophysiology
Abnormal lipid metabolism
macrocytosis
acanthocyte & target cells
End-stage cirrhosis
Decreased production of coag factors
Cirrhosis & advanced liver disease
Hypersplenism
decreased plt number
Bleeding
ANEMIA ASSOCIATED W/ ALCOHOLISM
Pathophysiology
Ethanol → direct toxicity
Malnutrition
Fe deficiency & megaloblastic anemia
Alcohol poisoning
Red cell characteristics
Vacuolization in erythroblast
Macrocytosis
Characteristics
Macrocyte and high MCV level decline after alcohol withdrawal 1-4 months
High cholesterol → acanthocytosis → loss of deformability → hemolysis
ANEMIA ASSOCIATED W/ RENAL DISEASE & RENAL FAILURE
Pathophysiology
Major cause → reduced Epo synthesis
Mild hemolysis caused by Na+/K+ ATPase defect and pentose phosphate shunt
Characteristics
Hypoproliferative
Electrolyte disturbance
leads to burr cells (echinocyte)