만성질환 빈혈, Anemia of chronic disease(ACD)

Anemia of chronic disease(ACD)

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1. ACD에서는 PBS에서 보통 normocytic, normochromic을 나타내지만 25% 미만의 경우에는 microcytic, hypochromic이기도 하며, 이 경우에 MCV는 70 fL보다 거의 작지 않습니다. MCH는 정상 또는 MCV와 유사하게 일정 케이스에서 낮으며, RDW는 정상~증가입니다. MCHC는 의미 있는 변화가 없습니다.

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2. ACD 빈혈은 많은 환자에서 경하지만, 약 20%에서는 좀 더 심하기도(Hb < 8 g/dL) 하며 absolute reticulocyte counts는 빈번하게 낮고 RBC 생성의 전체적인 감소를 반영합니다.

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3. 빈혈은 acute phase reactants(예, fibrinogen, ESR, CRP, ferritin, haptoglobin, factor VIII)뿐만 아니라 사이토카인(예, IL-6, IFN-r) 증가와 동반되기도 합니다.

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Laboratory findings in iron deficiency anemia, thalassemia, and anemia of chronic disease/inflammation

Test	Iron deficiency anemia	Alpha or beta thalassemia	Anemia of chronic disease/inflammation
Complete blood count
Hemoglobin	Decreased	Decreased	Decreased
Mean corpuscular volume (MCV)	Decreased	Decreased	Normal to decreased
Red cell distribution width (RDW)	Increased	Increased or normal	Normal to increased
Red blood cell count	Decreased	Increased or normal	Decreased
Iron studies
Serum iron	Decreased	Normal or increased	Decreased
Total iron-binding capacity (TIBC); transferrin	Increased	Normal	Decreased
Transferrin saturation	Decreased	Normal	Decreased
Serum ferritin	Decreased	Normal or increased	Increased
Erythrocyte protoporphyrin*	Increased	Normal or increased	Increased
Soluble transferrin receptor*	Increased	Increased	Normal
Reticulocyte hemoglobin equivalent (Ret-he or CHr)	Decreased	Decreased	Normal
C-reactive protein	Normal	Normal	Increased

Refer to UpToDate topics on anemia for further details of the evaluation and interpretation. Refer to UpToDate topic on iron deficiency anemia for early changes associated with iron deficiency (before

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REF. UpToDAte 2019.07.15