This shows you the differences between two versions of the page.
Both sides previous revisionPrevious revisionNext revision | Previous revision | ||
home:diseases:anemia [02.05.2017] – [Tests] sallieq | home:diseases:anemia [09.14.2022] (current) – external edit 127.0.0.1 | ||
---|---|---|---|
Line 3: | Line 3: | ||
====== Anemia ====== | ====== Anemia ====== | ||
- | Anemia of chronic disease, also referred to as anemia of inflammatory response, is a common condition seen in chronic illness.(({{pubmed> | + | < |
+ | |||
+ | Anemia of chronic disease, also referred to as anemia of inflammatory response, is a common condition seen in chronic illness.(({{pmid> | ||
Standard measures of iron status, such as ferritin, total iron-binding capacity, and serum iron are directly affected by chronic disease. In contrast, soluble transferrin receptor (sTfR) is elevated in iron deficiency but is not appreciably affected by chronic disease. | Standard measures of iron status, such as ferritin, total iron-binding capacity, and serum iron are directly affected by chronic disease. In contrast, soluble transferrin receptor (sTfR) is elevated in iron deficiency but is not appreciably affected by chronic disease. | ||
Line 14: | Line 16: | ||
< | < | ||
- | //**Eugene D. Weinberg**, "Iron Withholding: | + | //**Eugene D. Weinberg**, "Iron Withholding: |
- | The low levels of blood cells characteristic of anemia of chronic disease (ACD) are relatively common among autoimmune conditions(({{pubmed> | + | The low levels of blood cells characteristic of anemia of chronic disease (ACD) are relatively common among autoimmune conditions(({{pmid> |
- | However, Zarychanski and Houston state ACD is fundamentally an adaptive physiologic response which benefits the patient during times of infection(({{pubmed> | + | However, Zarychanski and Houston state ACD is fundamentally an adaptive physiologic response which benefits the patient during times of infection(({{pmid> |
- | Further, the ability of a particular species of bacteria to glean iron from its host is often a good indicator of its virulence. It is logical then that the body sequesters iron in response to an infection: Kemna et al. showed that injecting human volunteers with lipopolysaccharides, | + | Further, the ability of a particular species of bacteria to glean iron from its host is often a good indicator of its virulence. It is logical then that the body sequesters iron in response to an infection: Kemna et al. showed that injecting human volunteers with lipopolysaccharides, |
It might otherwise seem reasonable for a clinician to directly manage ACD using iron supplements or other antianemic therapies: fatigue and shortness of breath can be very unpleasant. However, administering this type of short-time palliation may lead to poorer outcomes. The possibility that ACD is an adaptive response by the host to microbes raises the specter that artificially resolving anemia subverts the immune response allowing microbes to spread by subverting the immune response and consequently allowing microbial infections to proliferate, | It might otherwise seem reasonable for a clinician to directly manage ACD using iron supplements or other antianemic therapies: fatigue and shortness of breath can be very unpleasant. However, administering this type of short-time palliation may lead to poorer outcomes. The possibility that ACD is an adaptive response by the host to microbes raises the specter that artificially resolving anemia subverts the immune response allowing microbes to spread by subverting the immune response and consequently allowing microbial infections to proliferate, | ||
Line 29: | Line 31: | ||
===== Tests ===== | ===== Tests ===== | ||
- | * **serum ferritin** – The protein in the blood that stores iron for later use by the body. Serum ferritin is also an acute phase reactant and will rise rapidly in the face of inflammation. May be high in anemia of chronic disease, especially if the liver is involved. Macrophages, | + | * **serum ferritin** – The protein in the blood that stores iron for later use by the body. Serum ferritin is also an acute phase reactant and will rise rapidly in the face of inflammation. May be high in anemia of chronic disease, especially if the liver is involved. Macrophages, |
- | * **serum iron** – The amount of iron being carried by transferrin in the blood plasma. On its own, serum iron provides no useful information. Serum iron has a diurnal variation that can be as much as 30% within a single individual. It is sensitive to the day's dietary iron intake and is affected by all the confounding diseases listed above. A low serum iron picked up as an incidental finding has a very low specificity for iron deficiency. Described further [[http:// | + | * **serum iron** – The amount of iron being carried by transferrin in the blood plasma. On its own, serum iron provides no useful information. Serum iron has a diurnal variation that can be as much as 30% within a single individual. It is sensitive to the day's dietary iron intake and is affected by all the confounding diseases listed above. A low serum iron picked up as an incidental finding has a very low specificity for iron deficiency. Described further [[https:// |
- | * **total iron binding capacity (TIBC)** – Shows if there is the "right amount" | + | * **total iron binding capacity (TIBC)** – Shows if there is the "right amount" |
* **soluble transferrin receptor (sTfR)** – Relatively new test. While standard measures of iron status such as ferritin, total iron-binding capacity, and serum iron are directly affected by chronic disease sTfR is elevated in iron deficiency but is not appreciably affected by chronic disease. A good way to verify anemia of chronic desease because it is not affected by inflammation. Should be considered for anemic patients whose differential diagnosis includes iron deficiency and anemia of inflammatory disease. | * **soluble transferrin receptor (sTfR)** – Relatively new test. While standard measures of iron status such as ferritin, total iron-binding capacity, and serum iron are directly affected by chronic disease sTfR is elevated in iron deficiency but is not appreciably affected by chronic disease. A good way to verify anemia of chronic desease because it is not affected by inflammation. Should be considered for anemic patients whose differential diagnosis includes iron deficiency and anemia of inflammatory disease. | ||
* **hemoglobin | * **hemoglobin | ||
Line 48: | Line 50: | ||
Male and females patients whose HGB falls to 11 and/or whose HCT falls to 28, should work with their doctors to [[home: | Male and females patients whose HGB falls to 11 and/or whose HCT falls to 28, should work with their doctors to [[home: | ||
+ | ===== Patients experiences ===== | ||
+ | < | ||
+ | My red blood count has risen into the normal range without any kind of iron or vitamin supplemenation. | ||
+ | |||
+ | // | ||
+ | |||
+ | < | ||
+ | When I was diagnosed with hypothyroidism (from Hashimoto' | ||
+ | |||
+ | Once I started thyroxine my life turned around, as I got most of my energy back and my thinning hair started growing back - but my arthritis was as bad as ever. | ||
+ | |||
+ | Fast forward 1 year - I found the MP and began phase one. Within days of starting mino I began to experience a metallic taste in my mouth. Could that metallic taste be ... metal? | ||
+ | |||
+ | I reckon all those iron-sequestering CWD monsters were dying and giving up all the iron back into my bloodstream. After a couple of months, my ferritin levels came down to normal again and the metallic taste went away at the same time. | ||
+ | |||
+ | So there you have it. | ||
+ | |||
+ | // | ||
===== Other treatments ===== | ===== Other treatments ===== | ||
Line 76: | Line 96: | ||
Doctors using these drugs are advised "to maintain the lowest hemoglobin level consistent with avoiding the need for transfusions." | Doctors using these drugs are advised "to maintain the lowest hemoglobin level consistent with avoiding the need for transfusions." | ||
- | A randomized controlled trial of critically ill patients showed erythropoiesis-stimulating agents did not reduce overall mortality.(({{pubmed> | + | A randomized controlled trial of critically ill patients showed erythropoiesis-stimulating agents did not reduce overall mortality.(({{pmid> |
===== Epidemiological studies ===== | ===== Epidemiological studies ===== | ||
- | In a 10 year follow up study from Chile, infants who already had high levels of hemoglobin proteins in their blood and were fed iron-fortified formula [[http:// | + | In a 10 year follow up study from Chile, infants who already had high levels of hemoglobin proteins in their blood and were fed iron-fortified formula [[https:// |
- | + | ||
- | + | ||
- | ===== Patients experiences ===== | + | |
- | + | ||
- | < | + | |
- | My red blood count has risen into the normal range without any kind of iron or vitamin supplemenation. | + | |
- | + | ||
- | // | + | |
- | + | ||
- | < | + | |
- | When I was diagnosed with hypothyroidism (from Hashimoto' | + | |
- | + | ||
- | Once I started thyroxine my life turned around, as I got most of my energy back and my thinning hair started growing back - but my arthritis was as bad as ever. | + | |
- | + | ||
- | Fast forward 1 year - I found the MP and began phase one. Within days of starting mino I began to experience a metallic taste in my mouth. Could that metallic taste be ... metal? | + | |
- | + | ||
- | I reckon all those iron-sequestering CWD monsters were dying and giving up all the iron back into my bloodstream. After a couple of months, my ferritin levels came down to normal again and the metallic taste went away at the same time. | + | |
- | + | ||
- | So there you have it. | + | |
- | + | ||
- | // | + | |
Line 108: | Line 107: | ||
{{tag> | {{tag> | ||
+ | < | ||
===== Notes and comments ===== | ===== Notes and comments ===== | ||
Line 122: | Line 122: | ||
* Legacy content | * Legacy content | ||
- | * [[http:// | + | * [[https:// |
- | * [[http:// | + | * [[https:// |
Given iron’s role as a key microbial nutrient, it may be that patients receiving blood plasma have significantly increased mortality as was reported in a randomized controlled trial(9971864) and why an | Given iron’s role as a key microbial nutrient, it may be that patients receiving blood plasma have significantly increased mortality as was reported in a randomized controlled trial(9971864) and why an | ||
Line 152: | Line 152: | ||
- | According to the textbook "An Introduction to Human Disease: Pathology and Pathophysiology Correlations" | + | According to the textbook "An Introduction to Human Disease: Pathology and Pathophysiology Correlations" |
GI bleeding | GI bleeding | ||
- | A simple outpatient two minute check of your stool for blood would rule out your doctor' | + | A simple outpatient two minute check of your stool for blood would rule out your doctor' |
Line 174: | Line 174: | ||
Lowering olmesartan might improve the RBC levels but at the cost increasing the anoxia and and impeding the healing in the kidneys. | Lowering olmesartan might improve the RBC levels but at the cost increasing the anoxia and and impeding the healing in the kidneys. | ||
- | for reference links, see full [[http:// | + | for reference links, see full [[https:// |
- | ===== References ===== | + | ===== References =====</ |