Anemia of inflammatory: does eiderr knowledge mean better diagnosis and treatment?
Authors:
Jaromír Tupý
Authors place of work:
FN
; Fakulta zdravotníctva, katolícka univerzita v Ružomberku
; Klinika hematológie a transfuziológie, ÚVN SNP Ružomberok –
Published in the journal:
Vnitř Lék 2023; 69(E-2): 10-18
Category:
Review Articles
doi:
https://doi.org/10.36290/vnl.2023.023
Summary
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:
diagnosis – treatment – hepcidin – anemia of inflammatory – iron homeostasis
Zdroje
1. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-1023.
2. 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.
3. Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019;3;133(1):40-50.
4. 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.
5. Stauder R, Valent P, Theurl I. Anemia at older age: etiologies, clinical implications, and management. Blood. 2018;131(5):505-514.
6. Ganz T. Anemia of Inflammation. N Engl J Med. 2019;381(12):1148-115
7. Camaschella C, Nai A, Silvestri L. Iron metabolism and iron disorders revisited in the hepcidin era. Haematologica. 2020;105(2):260-272.
8. Tupý J, et al. Železo v úlohe diferenciálnej diagnostiky anémií chronických ochorení. SAP - Slovak Academic Press, 2019.
9. 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.
10. 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.
11. Kawabata, H. Transferrin and transferrin receptors update. Free Radic. Biol. Med. 2019;133:46-54.
12. Sukhbaatar N, Weichhart T. Iron Regulation: Macrophages in Control. Pharmaceuticals. 2018;11:137.
13. 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.
14. Glogowski T, Wojtaszek E, Malyszko J. Biomarkers of iron metabolism in chronic kidney disease. International Urology and Nephrology. 2021;53:935-944
15. Wang CY, Babitt JL. Liver iron sensing and body iron homeostasis. Blood. 2019;133:18-29.
16. Arezes J, Foy N, McHugh K, et al. Erythroferrone inhibits the induction of hepcidin by BMP6. Blood. 2018;132(14):1473-1477.
17. 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.
18. 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.
19. 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.
20. Guida C, Altamura S, Klein FA, et al. A novel inflammatory pathway mediating rapid hepcidin‑ independent hypoferremia. Blood. 2015;125(14):2265-2275
21. 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.
22. Theurl I, Theurl M, Seifert M, et al. Autocrine formation of hepcidin induces iron retention in human monocytes. Blood. 2008;111:2392–2399.
23. Jelkmann W. Regulation of erythropoietin production. J Physiol. 2011;589(Pt 6):1251-1258.
24. 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.
25. 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.
26. 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.
27. 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.
28. Muckenthaler MU, Rivella S, Hentze MW. Gal, B.A. red carpet for iron metabolism. Cell. 2017;168(3):344-361
29. Camaschella C. Iron‑deficiency anemia. N Engl J Med. 2015;372(19):1832-1843
30. Lopez A, Cacoub P, Macdougall IC, Peyrin‑Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907-916.
31. Goodnough LT, Nemeth E, Ganz T. Detection, evaluation, and management of iron‑restricted erythropoiesis. Blood. 2010;116(23):4754-4761.
32. 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.
33. 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.
34. 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.
35. 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.
36. Nielsen OH, Soendergaard C, Vikner ME, Weiss G. Rational Management of Iron‑Deficiency Anaemia in Inflammatory Bowel Disease. Nutrients. 2018;10:82.
37. 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.
38. Zoller H, Schaefer B, Glodny B. Iron‑ induced hypophosphatemia: An emerging complication. Curr. Opin. Nephrol. Hypertens. 2017;26:266-275.
39. 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.
40. 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.
41. Goodnough LT, Murphy MF. Do liberal blood transfusions cause more harm than good? BMJ. 2014;349:g6897.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2023 Číslo E-2
Najčítanejšie v tomto čísle
- Severe autoimune thyreotoxicosis complicated by febrile neutropenia as a result of thyreostatic therapy
- Anemia of inflammatory: does eiderr knowledge mean better diagnosis and treatment?
- Diabetes mellitus urological complication
- Comparison of polypharmacy and pharmacotherapy among seniors in social institutions in 2001 and 2019