mani
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usually anemia of chronic disease is normocitic normochromic but may be microcytic hypochromic.If it is microcyric, what will happen to serum ferritin and stored iron in bone marrow? and why?
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| Sakaki-
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Would serum ferritin and iron stores in the bone marrow remain elevated? The ACD may manifest as a microcytic anemia if the disease increases in severity, and the iron still remains unable to be fully utilized in erythropoiesis.
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| mani
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yes, stores and serum ferritin are high. i jz wanna know the mechanism of this anemia. can somebody explain it?
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| Sakaki-
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They're not too sure about the mechanism of anemia of chronic disease, but it is believed that cytokines play an important role.
In anemia of chronic disease, there is decreased red cell survival, a blunted response of erythropoietin secretion to anemia, and a block of the transfer of iron from the monocyte-macrophage system (aka. reticuloendothelial system) (all supposedly caused by cytokines). Cytokines such as interferon-gamma are suggested to directly inhibit hematopoiesis as well.
TNF may cause increased sequestration of iron by macrophages, and there is also increased ferritin synthesis (from IL-1) which is not accompanied by a rise in transferrin receptors expression or transcription, leading to a pool of iron not available for hemoglobin synthesis.
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| rida
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Addition to sakaki's post which explains it pretty well, you basically have iron being trapped by macrophages which are holding onto the iron, not letting it go, hence ferritin is elevated but serum iron is decreased. There is some underlying chronic inflammatory disease that causes a rise in IL 1 which causes increased lactoferrin, which in turn will trap iron in bone marrow macrophages.
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| mani
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thanx everybody for contributing
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| Sakaki-
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There's also increased lactoferrin in the serum as well (from neutrophils).
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