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Cited by 124Iron Metabolism and DisordersErythropoietin and Anemia TreatmentHemoglobinopathies and Related Disorders

Anemia of chronic disease: pathophysiology and laboratory diagnosis.

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THOMAS, CHRISTIAN, THOMAS, LOTHAR·2005·Laboratory Hematology
DOI 10.1532/lh96.04049
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Abstract

Classic iron deficiency (ID) does not represent a challenge for the laboratory and physicians. The anemia that accompanies infection, inflammation, and cancer, commonly termed anemia of chronic disease (ACD), features apparently normal or increased iron stores. However, 20% of these patients have iron-restricted erythropoiesis (functional ID), an imbalance between the iron requirements of the erythroid marrow and the actual iron supply. Functional ID leads to a reduction in red cell hemoglobiniza-tion, causing hypochromic microcytic anemia. The diagnosis of functional ID in real time is based on measuring the hemoglobin content of reticulocytes. An examination of the biochemical markers of iron metabolism demonstrates weaknesses in the diagnosis of functional ID. We developed a diagnostic plot for the assessment of iron status in ACD and the detection of advancing ID in patients with ID, ACD, and the combined state of functional ID and ACD. The plot indicates the correlation between a marker of the iron supply for erythropoiesis (ie, the ratio of the soluble transferrin receptor value to the logarithm of the ferritin value) and the reticulocyte hemoglobin content and functions as a marker of iron demand. The diagnostic plot shows good selectivity for assessing the iron status of disease-specific anemias such as classic ID, end-stage renal failure, cancer-related anemia, and the anemia of infection and inflammation. The therapeutic implications of the diagnostic plot are to differentiate patients who should be administered oral iron supplements, recombinant human erythropoietin (r-HuEPO), or a combination of r-HuEPO and iron. The response of erythropoiesis to r-HuEPO depends on the iron supply and the proliferation of erythropoiesis. The lack of an increase or a decrease in reticulocyte hemoglobin levels indicates a nonresponder to r-HuEPO or functional ID.

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  • Cytokines and acute-phase proteins affect body iron homeostasis and macrophage iron metabolism leading to an inflammation driven diversion of iron traffic characterized by low circulating iron concentrations and high levels of ferritin, the latter reflecting iron retention in the MPS.

    “Thereby, cytokines and acute-phase proteins affect body iron homeostasis and macrophage iron metabolism leading to an inflammation driven diversion of iron traffic which is characterized by low circulating iron concentrations and high levels of the iron storage protein ferritin , the latter reflecting iron retention in the MPS (Thomas and Thomas, 2005; Weiss and Goodnough, 2005).”

    From Iron at the interface of immunity and infection (2014) · cites this paper as Thomas and Thomas, 2005

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Authors
THOMAS, C., & THOMAS, L.
Affiliations
  • Johannes Gutenberg University Mainz (DE)
  • Krankenhaus Nordwest (DE)
ORCID
Venue
Laboratory Hematology
Publisher
Carden Jennings Publishing Co.
Published
2005-03-01
Volume
11
Issue
1
Pages
14-23
ISSN
1080-2924 (ISSN-L)
DOI
10.1532/lh96.04049
OpenAlex
W1986616248
Cited by
124
References
51
Citations by year
2025: 3 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 4 · 2016: 7 · 2015: 8 · 2014: 6 · 2013: 6 · 2012: 7
FWCI
6.40
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Laboratory Hematology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
  • Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
Keywords
anemia of chronic disease, functional iron deficiency, iron-restricted erythropoiesis, reticulocyte hemoglobin content, soluble transferrin receptor, ferritin, iron status assessment, diagnostic plots, recombinant human erythropoietin, end-stage renal disease, cancer-related anemia, infection and inflammation, oral iron supplementation
MeSH terms
Bone Marrow, Chronic Disease, Erythropoiesis, Erythropoietin, Hematologic Tests, Humans, Inflammation, Iron, Neoplasms, Cytokines, Anemia, Iron-Deficiency

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