Vnitr Lek 2023, 69(2):E10-E18 | DOI: 10.36290/vnl.2023.023
Anemia of inflammatory: does eiderr knowledge mean better diagnosis and treatment?
- Klinika hematológie a transfuziológie, ÚVN SNP Ružomberok - FN
- Fakulta zdravotníctva, katolícka univerzita v Ružomberku
Anemia, which is a manifestation of the deterioration of patients' health and performance, is a common concomitant condition in diseases with signs of inflammation activation. This anemia - anemia of inflammation, is caused by disturbances of iron metabolism that lead to iron retention within macrophages, cytokine mediated inhibition of erythropoietin function and erythroid progenitor cell differentiation, and a reduced erytrocyte half-life. Anemia is usually mild to moderate, normocytic and normochromic. It is characterized by low iron circulation, but normal to increased levels of stored ferritin and the hormone hepcidin. The primary therapeutic approach is the treatment of the underlying inflammatory disease. In case of failure, iron supplementation and / or treatment with erythropoietin stimulating agents may be used. Blood transfusions are just an emergency treatment for life-threatening anemia. A new treatment modalities with hepcidin-modifying strategies and stabilizers of hypoxia inducible factors is emerging. However, their therapeutic efficacy needs to be verified and evaluated in clinical trials.
Keywords: anemia of inflammatory, iron homeostasis, hepcidin, diagnosis, treatment.
Accepted: March 29, 2023; Published: March 30, 2023 Show citation
References
- Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-1023.
Go to original source...
Go to PubMed...
- Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615-624.
Go to original source...
Go to PubMed...
- Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019;3;133(1):40-50.
Go to original source...
Go to PubMed...
- Tim Goodnough L, Comin‑Colet J, Leal‑Noval S, et al. Management of anemia in patients with congestive heart failure. Am J Hematol. 2017;92(1):88-93.
Go to original source...
Go to PubMed...
- Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood. 2018;131(5):505-514.
Go to original source...
Go to PubMed...
- Ganz T. Anemia of Inflammation. N Engl J Med. 2019;381(12):1148-115
Go to original source...
Go to PubMed...
- Camaschella C, Nai A, Silvestri L. Iron metabolism and iron disorders revisited in the hepcidin era. Haematologica. 2020;105(2):260-272.
Go to original source...
Go to PubMed...
- Tupý J, et al. Železo v úlohe diferenciálnej diagnostiky anémií chronických ochorení. SAP - Slovak Academic Press, 2019.
- Lanser L, Fuchs D, Kurz K, Weiss G. Physiology and Inflammation Driven Pathophysiology of Iron Homeostasis‑Mechanistic Insights into Anemia of Inflammation and Its Treatment. Nutrients. 2021;13:3732.
Go to original source...
Go to PubMed...
- González‑Domínguez Á, Visiedo‑García FM, Domínguez‑Riscart J, et al. Iron Metabolism in Obesity and Metabolic Syndrome. Int. J. Mol. Sci. 2020;21(15):5529.
Go to original source...
Go to PubMed...
- Kawabata, H. Transferrin and transferrin receptors update. Free Radic. Biol. Med. 2019;133:46-54.
Go to original source...
Go to PubMed...
- Sukhbaatar N, Weichhart T. Iron Regulation: Macrophages in Control. Pharmaceuticals. 2018;11:137.
Go to original source...
Go to PubMed...
- Babitt JL, Eisenga MF, Haase VH, et al. Controversies in optimal anemia management: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference. Kidney International. 2021;99:1280-1295.
Go to original source...
Go to PubMed...
- Glogowski T, Wojtaszek E, Malyszko J. Biomarkers of iron metabolism in chronic kidney disease. International Urology and Nephrology. 2021;53:935-944
Go to original source...
Go to PubMed...
- Wang CY, Babitt JL. Liver iron sensing and body iron homeostasis. Blood. 2019;133:18-29.
Go to original source...
Go to PubMed...
- Arezes J, Foy N, McHugh K, et al. Erythroferrone inhibits the induction of hepcidin by BMP6. Blood. 2018;132(14):1473-1477.
Go to original source...
Go to PubMed...
- Ueda N, Takasawa K. Impact of inflammation on ferritin, hepcidin and the management of iron deficiency anemia in chronic kidney disease. Nutrients. 2018;10(9):1173.
Go to original source...
Go to PubMed...
- Nemeth E, Tuttle MS, Powelson J, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science. 2004;306(5704):2090-2093.
Go to original source...
Go to PubMed...
- Canali S, Core AB, Zumbrennen‑Bullough KB, et al. Activin B induces noncanonical SMAD1/5/8 signaling via BMP type i receptors in hepatocytes: evidence for a role in hepcidin induction by inflammation in male mice. Endocrinology. 2016;157(3):1146-1162.
Go to original source...
Go to PubMed...
- Guida C, Altamura S, Klein FA, et al. A novel inflammatory pathway mediating rapid hepcidin‑independent hypoferremia. Blood. 2015;125(14):2265-2275
Go to original source...
Go to PubMed...
- Nairz M, Theurl I, Swirski FK, Weiss G. "Pumping iron"-how macrophages handle iron at the systemic, microenvironmental, and cellular levels. Pflugers Arch. 2017;469(3-4):397-418.
Go to original source...
Go to PubMed...
- Theurl I, Theurl M, Seifert M, et al. Autocrine formation of hepcidin induces iron retention in human monocytes. Blood. 2008;111:2392-2399.
Go to original source...
Go to PubMed...
- Jelkmann W. Regulation of erythropoietin production. J Physiol. 2011;589(Pt 6):1251-1258.
Go to original source...
Go to PubMed...
- Khalil S, Delehanty L, Grado S, et al. Iron modulation of erythropoiesis is associated with Scribble‑mediated control of the erythropoietin receptor. J Exp Med. 2018;215(2):661-679.
Go to original source...
Go to PubMed...
- Latour C, Wlodarczyk MF, Jung G, et al. Erythroferrone contributes to hepcidin repression in a mouse model of malarial anemia. Haematologica. 2017;102(1):60-68.
Go to original source...
Go to PubMed...
- Kim A, Fung E, Parikh SG, et al. A mouse model of anemia of inflammation: complex pathogenesis with partial dependence on hepcidin. Blood.2014;123:1129-1136.
Go to original source...
Go to PubMed...
- Dinkla S, van Eijk LT, Fuchs B, et al. Inflammation‑associated changes in lipid composition and the organization of the erythrocyte membrane. BBA Clin. 2016;5:186-192.
Go to original source...
Go to PubMed...
- Muckenthaler MU, Rivella S, Hentze MW. Gal, B.A. red carpet for iron metabolism. Cell. 2017;168(3):344-361
Go to original source...
Go to PubMed...
- Camaschella C. Iron‑deficiency anemia. N Engl J Med. 2015;372(19):1832-1843
Go to original source...
Go to PubMed...
- Lopez A, Cacoub P, Macdougall IC, Peyrin‑Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907-916.
Go to original source...
Go to PubMed...
- Goodnough LT, Nemeth E, Ganz T. Detection, evaluation, and management of iron‑restricted erythropoiesis. Blood. 2010;116(23):4754-4761.
Go to original source...
Go to PubMed...
- van Santen S, de Mast Q, Oosting JD, van Ede A, Swinkels DW, van der Ven AJ. Hematologic parameters predicting a response to oral iron therapy in chronic inflammation. Haematologica. 2014;99(9):e171-e173.
Go to original source...
Go to PubMed...
- Bregman DB, Morris D, Koch TA, He A, Goodnough LT. Hepcidin levels predict nonresponsiveness to oral iron therapy in patients with iron deficiency anemia. Am J Hematol. 2013;88(2):97-101.
Go to original source...
Go to PubMed...
- Thomas C, Kobold U, Thomas L. Serum hepcidin-25 in comparison to biochemical markers and hematological indices for the differentiation of iron‑restricted erythropoiesis. Clin Chem Lab Med. 2011;49(2):207-213.
Go to original source...
Go to PubMed...
- Vallurupalli M, MacFadyen JG, Glynn RJ, et al. Effects of Interleukin-1 Inhibition on Incident Anemia: Exploratory Analyses From a Randomized Trial. Ann. Intern. Med. 2020;172:523-532.
Go to original source...
Go to PubMed...
- Nielsen OH, Soendergaard C, Vikner ME, Weiss G. Rational Management of Iron‑Deficiency Anaemia in Inflammatory Bowel Disease. Nutrients. 2018;10:82.
Go to original source...
Go to PubMed...
- Girelli D, Ugolini S, Busti F, Marchi G, Castagna A. Modern iron replacement therapy: Clinical and pathophysiological insights. Int. J. Hematol. 2018;107:16-30.
Go to original source...
Go to PubMed...
- Zoller H, Schaefer B, Glodny B. Iron‑induced hypophosphatemia: An emerging complication. Curr. Opin. Nephrol. Hypertens. 2017;26:266-275.
Go to original source...
Go to PubMed...
- Portolés J, Martín L, Broseta JJ, Cases A. Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Front. Med. 2021;8:642296.
Go to original source...
Go to PubMed...
- Petzer V, Tymoszuk P, Asshoff M, Carvalho J, et al. A fully human anti‑BMP6 antibody reduces the need for erythropoietin in rodent models of the anemia of chronic disease. Blood. 2020;136:1080-1090.
Go to original source...
Go to PubMed...
- Goodnough LT, Murphy MF. Do liberal blood transfusions cause more harm than good? BMJ. 2014;349:g6897.
Go to original source...
Go to PubMed...