Anemia of Chronic Diseases

AUTOIMMUNE THROMBOCYTOPENIA , , , ,

NV Kurkina, EI Gorshenina, LV Chegodaeva, AV Polagimova

NP Ogarev National Research Mordovia State University, 68 Bolshevistskaya str., Saransk, Russian Federation, 430005

For correspondence: Nadezhda Viktorovna Kurkina, MD, PhD, 26А Ul’yanova str., Saransk, Russian Federation, 430032; Tel.: +7(927)172-48-63; e-mail: nadya.kurckina@yandex.ru

For citation: Kurkina NV, Gorshenina EI, Chegodaeva LV, Polagimova AV. Anemia of Chronic Diseases. Clinical oncohematology. 2021;14(3):347–54. (In Russ).

DOI: 10.21320/2500-2139-2021-14-3-347-354

ABSTRACT

Anemia of chronic diseases (ACD) refers to a group of anemias arising in various inflammatory infections, autoimmune or tumor diseases due to acute or chronic immune activation. ACD ranks second in incidence after iron deficiency anemia (IDA). Within the variety of pathogenetic mechanisms one of the primary ones is hepcidin synthesis in hepatocytes, which blocks iron absorption in the intestine and contributes to its deposition in cells of the monocyte-macrophage system. Besides, excessive cytokines in such diseases and pathologies lead to lower erythropoietin production which does not correspond to the severity grade of anemia. This results in impaired erythropoiesis in the bone marrow. The differential diagnosis should also specify iron deficiency type (the absolute one in IDA and the functional one in ACD). The effective treatment of the main disease and anemia correction speed up the improvement of patient’s status, rehabilitation, and quality of life.

Keywords: anemia, chronic diseases, immune system, hepcidin, cytokines, erythropoietin, ferritin, serum iron.

Received: January 17, 2021

Accepted: April 30, 2021

Read in PDF

Статистика Plumx английский

REFERENCES

  1. Андреичев Н.А., Балеева Л.В. Анемия хронических заболеваний. Российский медицинский журнал. 2014;20(2):50–5.
    [Andreichev NA, Baleeva LV. Anemia of chronic diseases. Rossiiskii meditsinskii zhurnal. 2014;20(2):50–5. (In Russ)]
  2. Волкова С.А., Боровков Н.Н. Основы клинической гематологии: учебное пособие. Н. Новгород: НижГМА, 2013. 400 с.
    [Volkova SA, Borovkov NN. Osnovy klinicheskoi gematologii: uchebnoe posobie. (Fundamentals of clinical hematology: learning guide.) Nizhny Novgorod: NizhGMA Publ.; 2013. 400 p. (In Russ)]
  3. John M, Hoernig S, Doehner W, et al. Anemia and inflammation in COPD. Chest. 2005;127(3):825–9. doi: 10.1378/chest.127.3.825.
  4. Будневский А.В., Есауленко И.Е., Овсянников Е.С., Жусина Ю.Г. Анемия при хронической обструктивной болезни легких. Терапевтический архив. 2016;88(3):96–9. doi: 10.17116/terarkh201688396-99.
    [Budnevsky AV, Esaulenko IE, Ovsyannikov ES, Zhusina YuG. Anemia in chronic obstructive pulmonary disease. Terapevticheskii arkhiv. 2016;88(3):96–9. doi: 10.17116/terarkh201688396-99. (In Russ)]
  5. Жусина Ю.Г., Будневский А.В., Феськова А.А., Овсянников Е.С. О взаимосвязи хронической обструктивной болезни легких и анемии. Пульмонология. 2018;28(6):730–5. doi: 10.18093/0869-0189-2018-28-6-730-735.
    [Zhusina YuG, Budnevskiy AV, Fes’kova AA, Ovsyannikov ES. About relationship between chronic obstructive pulmonary disease and anemia. Pulmonologiya. 2018;28(6):730–5. doi: 10.18093/0869-0189-2018-28-6-730-735. (In Russ)]
  6. Tsantes AE, Tassiopoulos ST, Papadhimitriou SI, et al. Theophylline treatment may adversely affect the anoxia-induced erythropoietic response without suppressing erythropoietin production. Eur J Clin Pharmacol. 2003;59(5–6):379–83. doi: 10.1007/s00228-003-0640-0.
  7. Marathias KP, Agroyannis B, Mavromoustakos T, et al. Hematocrit-lowering effect following inactivation of renin-angiotensin system with angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Curr Top Med Chem. 2004;4(4):483–6. doi: 10.2174/1568026043451311.
  8. Рукавицын О.А. Гематология. Национальное руководство. М.: ГЭОТАР-Медиа, 2017. 784 с.
    [Rukavitsyn OA. Natsional’noe rukovodstvo. (Hematology. National Guidelines.) Moscow: GEOTAR-Media Publ.; 2017. 784 p. (In Russ)]
  9. Groenveld HF, Januzzi JL, Damman K, et al. Anemia and mortality in heart failure patients a systematic review and meta-analysis. J Am Coll Cardiol. 2008;52(10):818–27. doi: 10.1016/j.jacc.2008.04.061.
  10. Снеговой А.В., Aapro M., Гладков О.А. и др. Практические рекомендации по лечению анемии у онкологических больных. Злокачественные опухоли. 2016;4:368–77.
    [Snegovoi AV, Aapro M, Gladkov OA, et al. Practical guidelines for anemia treatment in oncological patients. Zlokachestvennye opukholi. 2016;4:368–77. (In Russ)]
  11. Voulgari PV, Kolios G, Papadopoulos GK, et al. Role of cytokines in the pathogenesis of anemia of chronic disease in rheumatoid arthritis. Clin Immunol. 1999;92(2):153–60. doi: 10.1006/clim.1999.4736.
  12. Stauffer ME, Fan T. Prevalence of Anemia in Chronic Kidney Disease in the United States. PLoS One. 2014;9(1):e84943. doi: 10.1371/journal.pone.0084943.
  13. McClellan W, Aronoff SL, Bolton WK, et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Ress Opion. 2004;20(9):1501–10. doi: 10.1185/030079904X2763.
  14. Stenvinkel P. The role of inflammation in the anaemia of end-stage renal disease. Nephrol Dial Transplant. 2001;16(Suppl 7):36–40. doi: 10.1093/ndt/16.suppl_7.36.
  15. Thorp ML, Johnson ES. Effect of anemia on mortality, cardiovascular hospitalizations and end stage renal disease among patients with chronic kidney disease. Nephrology. 2009;14(2):240–6. doi: 10.1111/j.1440-1797.2008.01065.x.
  16. Andrews M, Arredondo M. Ferritin levels and hepcidin mRNA expression in peripheral mononuclear cells from anemic type 2 diabetic patients. Biol Trace Elem Res. 2012;149(1):1–4. doi: 10.1007/s12011-012-9389-6.
  17. Zoppini G, Targher G, Chonchol M, et al. Anaemia, independent of chronic kidney disease, predicts all cause and cardiovascular mortality in type 2 diabetic patients. Atherosclerosis. 2010;210(2):575–80. doi: 10.1016/j.atherosclerosis.2009.12.008.
  18. Ito H, Takeuchi Y, Ishida H, et al. Mild anemia is frequent and associated with micro- and macroangiopathies in patients with type 2 diabetes mellitus. J Diab Invest. 2010;1(6):273–8. doi: 10.1111/j.2040-1124.2010.00060.x.
  19. Roy CN, Mak HH, Akpan I, et al. Hepcidin antimicrobial peptide transgenic mice exhibit features of the anemia of inflammation. Blood. 2007;109(9):4038–44. doi: 10.1182/blood-2006-10-051755.
  20. Ganz T, Nemeth E. Iron sequestration and anemia of inflammation. Semin Hematol. 2009;46(4):387–393. doi: 10.1053/j.seminhematol.2009.06.001.
  21. Морщакова Е.Ф., Павлов А.Д., Румянцев А.Г. Эритропоэз, эритропоэтин, железо. М.: ГЭОТАР-Медиа, 2013. 178 с.
    [Morshchakova EF, Pavlov AD, Rumyantsev AG. Eritropoez, eritropoetin, zhelezo. (Erythropoiesis, erythropoietin, iron.) Moscow: GEOTAR-Media Publ.; 2013. 178 p. (In Russ)]
  22. Рукавицын О.А. Анемия хронических заболеваний: отдельные аспекты патогенеза и пути коррекции. Онкогематология. 2016;11(1):37–46. doi: 10.17650/1818-8346-2016-11-1-37-46.
    [Rukavitsyn OA. Anemia of chronic diseases: the important aspects of pathogenesis and treatment. Oncohematology. 2016;11(1):37–46. doi: 10.17650/1818-8346-2016-11-1-37-46. (In Russ)]
  23. Румянцев А.Г., Масчан А.А. Федеральные клинические рекомендации по диагностике и лечению анемии хронических заболеваний (электронный документ). Доступно по: https://nodgo.org/sites/default/files/%D0%A4%D0%9A%D0%A0%20%D0%BF%D0%BE%20%D0%B4%D0%B8%D0%B0%D0%B3%D0%BD%D0%BE%D1%81%D1%82%D0%B8%D0%BA%D0%B5%20%D0%B8%20%D0%BB%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D1%8E%20%D0%B0%D0%BD%D0%B5%D0%BC%D0%B8%D0%B8%20%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B8%D1%85%20%D0%B1%D0%BE%D0%BB%D0%B5%D0%B7%D0%BD%D0%B5%D0%Bpdf. Ссылка активна на 13.04.2021.
    [Rumyantsev AG, Maschan AA. Federal clinical guidelines for diagnosis and treatment of anemia of chronic diseases. [Internet] Available from: https://nodgo.org/sites/default/files/%D0%A4%D0%9A%D0%A0%20%D0%BF%D0%BE%20%D0%B4%D0%B8%D0%B0%D0%B3%D0%BD%D0%BE%D1%81%D1%82%D0%B8%D0%BA%D0%B5%20%D0%B8%20%D0%BB%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D1%8E%20%D0%B0%D0%BD%D0%B5%D0%BC%D0%B8%D0%B8%20%D1%85%D1%80%D0%BE%D0%BD%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B8%D1%85%20%D0%B1%D0%BE%D0%BB%D0%B5%D0%B7%D0%BD%D0%B5%D0%B9.pdf. (accessed 13.04.2021) (In Russ)]
  24. Nemeth E, Ganz T. Anemia of Inflammation. Hematol Oncol Clin North Am. 2014;28(4):671–81. doi: 10.1016/j.hoc.2014.04.005.
  25. Weiss Pathogenesis and treatment of anemia of chronic disease. Blood Rev. 2002;16(2):87–96. doi: 10.1054/blre.2002.0193.
  26. Сморкалова Е.В. Иммуногематологические особенности железодефицитной анемии и анемии хронических заболеваний: Автореф. дис.… канд. мед. наук. Уфа, 2012. 22 с.
    [Smorkalova EV. Immunogematologicheskie osobennosti zhelezodefitsitnoi anemii i anemii khronicheskikh zabolevanii. (Immunohematological characteristics of iron deficiency anemia and anemia of chronic diseases.) [dissertation] Ufa; 2012. 22 p. (In Russ)]
  27. Kato Y, Takagi C, Tanaka J, et al. Effect of daily subcutaneous administration of recombinant erythropoietin on chronic anemia in rheumatoid arthritis. Intern Med. 1994;33(4):193–7. doi: 10.2169/internalmedicine.33.193.
  28. Peeters HR, Jongen-Lavrencic M, Bakker CH, et al. Recombinant human erythropoietin improves health-related quality of life in patients with rheumatoid arthritis and anaemia of chronic disease; utility measures correlate strongly with disease activity measures. Rheumatol Int. 1999;18(5–6):201–6. doi: 10.1007/s002960050085.
  29. Arndt U, Kaltwasser JP, Gottschalk R, et al. Correction of iron-deficient erythropoiesis in the treatment of anemia of chronic disease with recombinant human erythropoietin. Ann Hematol. 2005;84(3):159–66. doi: 10.1007/s00277-004-0950-z.
  30. Schipperus M, Rijnbeek B, Reddy M, et al. CNTO328 (Anti-IL-6 mAb) Treatment Is Associated with An Increase in Hemoglobin (Hb) and Decrease in Hepcidin Levels in Renal Cell Carcinoma (RCC). Blood. 2009;114(22):4045. doi: 10.1182/blood.v114.22.4045.4045.
  31. Hohlbaum A, Gille H, Christian J, et al. Iron mobilization and pharmacodynamic marker measurements in non-human primates following administration of PRS-080, a novel and highly specific antihepcidin therapeutic. Am J Hematol. 2013;88(5):E41.
  32. Schwoebel F, van Eijk LT, Zboralski D, et al. The effects of the anti-hepcidin Spiegelmer NOX-H94 on inflammation-induced anemia in cynomolgus monkeys. Blood. 2013;121(12):2311–5. doi: 10.1182/blood-2012-09-456756.
  33. Poli M, Girelli D, Campostrini N, et al. Heparin: a potent inhibitor of hepcidin expression in vitro and in vivo. Blood. 2011;117(3):997–1004. doi: 10.1182/blood-2010-06-289082.
  34. Crosby JR, Gaarde WA, Egerston J, et al. Targeting hepcidin with antisense oligonucleotides improves anemia endpoints in mice. Blood. 2006;108(11, Pt 1):269. doi: 10.1182/blood.v108.11.269.269.
  35. Akinc A, Chan-Daniels A, Sehgal A, et al. Targeting the hepcidin pathway with RNAi therapeutics for the treatment of anemia. Blood. 2011;118(21):688. doi: 10.1182/blood.v118.21.688.688.
  36. Гармиш Е.А. Анемия хронического воспаления при ревматоидном артрите: патогенез и выбор терапии. Украинский ревматологический журнал. 2016;1(63):39–41.
    [Garmish EА. Anemia of chronic inflammation of rheumatoid arthritis: pathogenesis and choice of treatment. Ukrainskii revmatologicheskii zhurnal. 2016;1(63):39–41. (In Russ)]