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Course: Health and medicine > Unit 6
Lesson 6: Iron deficiency anemia and anemia of chronic diseaseChronic disease vs iron deficiency anemia
Created by Nauroz Syed.
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why size of red cell is small in microcytic anaemia(4 votes)
It's all to do with the heme. There is less hemoglobin put in because of less iron and that means that there is less hemoglobin on the RBC (red blood cell) and that means that the body tries to make the cell smaller.
To get this a little better, imagine if you had a donut that only had 6 M&Ms on it then they might make the donut 6m big (sarcasm intended). But say they only had a little bit of M&Ms. That means that they might make a smaller amount of donut so it still looks like it has a lot on each (like its proportional).
That is how microcytic anemia makes cells small.(3 votes)
Can anemia of chronic disease be normocytic?(3 votes)
At3:20, in anemia of chronic disease, why TIBC is decrease?
TIBC means amount of trasferrin. so if TIBC (transferrin) is increase, iron can be storage in to liver (ferritin can be increased), and serum iron is decreased (bacteria can't use iron in serum). i undertood like this.. could you explain easily please? :)(2 votes)
I believe that it may be due to the fact that more ferritin is stored in anaemia of chronic disease. High ferritin levels downregulates transferrin because the the body 'thinks' that iron levels are ample (just not available to the body).
Read this for more info - http://www.irondisorders.org/anemia-of-chronic-disease(1 vote)
- Doesn't ferretin increase in chronic inflammation/disease because it is an acute phase protein? Well, what makes it an acute phase protein? Is it that there is an increase in iron store?(2 votes)
I understand why there would be raised ferritin in chronic disease but what is the mechanism that the body uses to raise ferritin? Hepcidin does not appear to be related.(1 vote)
Hepcidin is responsible for the breakdown of iron channels in the cells. When there is not enough hepcidin, the iron receptors remain open allowing more iron intake. The iron is stored in ferritin. Less hepcidin= more iron. More iron= more ferritin.(1 vote)
- Does high levels of TFR2 downregulate of hepcidin?
I mean when the cell needs iron it upregulates of TFR and the hepcidin is supposed to be downregulated so that more iron is entering the blood??
What about HFE? It’s supposed to upregulate hepcidin, and that’s why iron overload is developed with mutations in HFE?(1 vote) 
how come i have no idea what this is(1 vote)
3:20Video transcript
- So let's talk about some
of the differences between anemia of chronic disease
and iron-deficiency anemia, because really these two
diseases present very similarly. Both of them are going
to have patients that present with signs and symptoms of anemia. So, patients that are chronically
fatigued and feeling weak, looking paler than usual, and maybe experiencing
some shortness of breath. And really, when you go to
draw the basic anemia labs, take a look at what's
going on in the blood, you'll see that both of
them are microcytic anemias. So, really the only way to
tell these two diseases apart is to draw iron studies. So let's take a look at what some of those values would show. So, here's some of the
values that you get back when you draw iron studies, and we already went through
this for iron-deficiency anemia, but let's just do it
again for practice sake. So, with iron-deficiency
anemia you'd expect your serum iron to be decreased, right? Hence, the iron deficiency part of it all. The percent saturation or the percentage of total binding sites on the transferrin
molecules that are actually occupied by iron would also be decreased. The total iron binding capacity
in iron-deficiency anemia is increased, and we said that that was the body's compensatory mechanism to deal with the deficiency in iron. So what the body does to deal
with the shortage of iron is increase its production
of transferrin molecules. It makes more transferrin,
puts it out into the blood, so that the transferrin can go out there and bind to more iron, to find more iron and
bind to more of it, okay? And ferritin, which is reflective of the amount of iron that's
in storage in the body is decreased in iron deficiency, okay? So, those are the values
for iron-deficiency anemia. Let's compare that with what you see in anemia of chronic disease. So just as an overview, once again, anemia of chronic disease
is a disease where you have some underlying inflammatory condition, and as a result of it, you
have an increased production of a molecule called hepcidin, and what hepcidin does is it, number one, decreases the absorption
of iron from the gut, and it also decreases
the recycling of iron from the breakdown of red blood cells. So, really what your body is trying to accomplish in this disease
is, it's trying to limit how much iron is coming into the body and at the same time
it's trying to tuck away as much iron as possible into storage, so that very little is
present in the blood. In essence, the body's trying to play keep away with the iron, away from bacteria and inflammatory cells, because they really need it
to thrive and to grow, okay? So, you'd expect that the serum iron in anemia of chronic
disease would be decreased. That's exactly what the
body's trying to accomplish. It wants very little iron
present in the blood. The percent saturation, which is again the percentage
of transferrin binding sites that are actually filled up with iron, would also be decreased. The total iron binding capacity, or the amount of transferrin
that's in the blood in anemia of chronic
disease, is decreased. And again, this makes sense. It goes totally in line with what the body's trying to accomplish. It decreases the production of transferrin so that there's less transferrin
out there in the blood trying to bind to iron, okay? And finally, the ferritin,
which is reflective of the total amount of iron
in storage in the body in anemia of chronic disease is characteristically increased, and this is because once again the body has tucked away as much iron
as possible into storage, okay, which is reflective of
what you see with ferritin. So, really there are a
couple of differences between iron-deficiency anemia and
anemia of chronic disease. Firstly, iron-deficiency anemia is really a disease of total body depletion of iron, and these lab values
reflect that very well, especially the ferritin. This tells you that there
is no iron in the body, not even in storage, not in the blood, not in the storage, not anywhere. Anemia of chronic disease, however, isn't necessarily a disease where you have a depletion in iron. Instead, you'll see an
increase in ferritin, so that tells you that
there's iron in the body, it's just tucked away,
away from the access of bacteria and inflammatory cells. Now, also another difference
between these two diseases is that in iron-deficiency anemia the body is doing its absolute best to increase the amount of
iron available in the serum, and you see that with the
total iron binding capacity. It increases the
production of transferrin. It does its best to try to bring more iron into the body and into the blood. However, in anemia of chronic disease the body is trying to
accomplish the exact opposite. It's decreasing its
production of transferrin so that you have as little
iron as possible in the serum, and the increased ferritin also reflects that the body's trying to
hide away its iron in storage. So, in summary, those are
some of the differences between anemia of chronic disease and iron-deficiency anemia, which again, you really rely on these iron studies to differentiate between, because they present very similarly. What's important to keep in mind is that these are both microcytic anemias.