Anemia of inflammation, also known as anemia of chronic disease, is a common form of hypoproliferative anemia arising in the setting of inflammation. The pathophysiology of anemia of inflammation consists of three features: (1) iron sequestration, (2) blunting or suppression of the erythropoietin response, and (3) shortened red cell survival (Cartwright and Lee, Br J Haematol. 21:147–52, 1971; Weiss et al., Blood 133:40–50, 2019). The characteristic pattern of iron indices in anemia of inflammation is a low serum iron, a low serum transferrin or total iron binding capacity, and an elevated serum ferritin reflecting an inflammatory state with adequate or increased reticular endothelial iron stores (Cartwright and Lee, Br J Haematol. 21:147–52, 1971; Means, Curr Hematol Rep. 2:116–21, 2003; Nemeth et al., Blood. 101:2461–3, 2003). The central factor driving the anemia of inflammation is an elevation in hepcidin arising from inflammatory cytokines, leading to impaired gastrointestinal absorption and tissue mobilization of iron with a consequent state of iron-restricted erythropoiesis (Fertrin, Hematology Am Soc Hematol Educ Program 2020:478–86, 2020). Anemia of renal disease and anemia of malignancy share mechanistic features in common with anemia of inflammation.

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Anemia of Inflammation

  • Alfred Ian Lee

摘要

Anemia of inflammation, also known as anemia of chronic disease, is a common form of hypoproliferative anemia arising in the setting of inflammation. The pathophysiology of anemia of inflammation consists of three features: (1) iron sequestration, (2) blunting or suppression of the erythropoietin response, and (3) shortened red cell survival (Cartwright and Lee, Br J Haematol. 21:147–52, 1971; Weiss et al., Blood 133:40–50, 2019). The characteristic pattern of iron indices in anemia of inflammation is a low serum iron, a low serum transferrin or total iron binding capacity, and an elevated serum ferritin reflecting an inflammatory state with adequate or increased reticular endothelial iron stores (Cartwright and Lee, Br J Haematol. 21:147–52, 1971; Means, Curr Hematol Rep. 2:116–21, 2003; Nemeth et al., Blood. 101:2461–3, 2003). The central factor driving the anemia of inflammation is an elevation in hepcidin arising from inflammatory cytokines, leading to impaired gastrointestinal absorption and tissue mobilization of iron with a consequent state of iron-restricted erythropoiesis (Fertrin, Hematology Am Soc Hematol Educ Program 2020:478–86, 2020). Anemia of renal disease and anemia of malignancy share mechanistic features in common with anemia of inflammation.