WordNet

an impairment of health or a condition of abnormal functioning
being long-lasting and recurrent or characterized by long suffering; "chronic indigestion"; "a chronic shortage of funds"; "a chronic invalid"
of long duration; "chronic money problems" (同)continuing
habitual; "a chronic smoker" (同)inveterate
caused by or altered by or manifesting disease or pathology; "diseased tonsils"; "a morbid growth"; "pathologic tissue"; "pathological bodily processes" (同)morbid, pathologic, pathological
a deficiency of red blood cells (同)anaemia
a lack of vitality (同)anaemia

PrepTutorEJDIC

《所有・所属》…『の』,…のものである,…に属する・《材料・要素》…『でできた』,から成る・《部分》…『の』[『中の』] ・《数量・単位・種類を表す名詞に付いて》…の・《原因・動機》…『で』,のために(because of) ・《主格関係》…『の』,による,によって・《目的格関係》…『を』,の・《同格関係》…『という』・《関係・関連》…『についての』[『の』],の点で・《抽象名詞などと共に》…の[性質をもつ] ・《『It is』+『形』+『of』+『名』+『to』 doの形で,ofの後の名詞を意味上の主語として》・《分離》…『から』・《起原・出所》…『から』[『の』](out of) ・《『名』+『of』+『a』(『an』)+『名』の形で》…のような・《『名』+『of』+『mine』(『yours, his』など独立所有格)の形で》…の…・《時》(1)《副詞句を作って》…に《形容詞句を作って》…の・《時刻》《米》…前(to,《米》before)
(体の)『病気』,疾患 / (精神・道徳などの)病気,病弊
女性の話術芸人 =diseur
(病気が)長期にわたる,慢性の / 《名詞の前にのみ用いて》常習の,癖になった
病気にかかった / 病的な,不健全な(morbid)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/22 21:53:47」(JST)

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Anemia of chronic disease, or anemia of chronic inflammation, is a form of anemia seen in chronic infection, chronic immune activation, and malignancy. These conditions all produce massive elevation of Interleukin-6, which stimulates hepcidin production and release from the liver, which in turn reduces the iron carrier protein ferroportin so that access of iron to the circulation is reduced. Other mechanisms may also play a role, such as reduced erythropoiesis.

Anemia of chronic inflammation is the preferred term since not all chronic diseases are associated with this form of anemia.

Pathophysiology

Anemia is considered when RBCs count :

< 4.5 million in males
< 3.9 million in females

Or Hemoglobin ( Hb ) content :

< 13.5 gm % in males
< 11.5 gm % in females

In response to inflammatory cytokines, increasingly IL-6,^[1] the liver produces increased amounts of hepcidin. Hepcidin in turn causes increased internalisation of ferroportin molecules on cell membranes which prevents release from iron stores. Inflammatory cytokines also appear to affect other important elements of iron metabolism, including decreasing ferroportin expression, and probably directly blunting erythropoiesis by decreasing the ability of the bone marrow to respond to erythropoietin.

Before the recent discovery of hepcidin and its function in iron metabolism, anemia of chronic disease was seen as the result of a complex web of inflammatory changes. Over the last few years, however, many investigators have come to feel that hepcidin is the central actor in producing anemia of chronic inflammation. Hepcidin offers an attractive Occam's Razor (parsimonious) explanation for the condition, and more recent descriptions of human iron metabolism and hepcidin function reflect this view.^[2]

In addition to effects of iron sequestration, inflammatory cytokines promote the production of white blood cells. Bone marrow produces both white blood cells and red blood cells from the same precursor stem cells. Therefore, the upregulation of white blood cells causes fewer stem cells to differentiate into red blood cells. This effect may be an important additional cause for the decreased erythropoiesis and red blood cell production seen in anemia of inflammation, even when erythropoietin levels are normal, and even aside from the effects of hepcidin. Nonetheless, there are other mechanisms that also contribute to the lowering of hemoglobin levels during inflammation: (i) Inflammatory cytokines suppress the proliferation of erythroid precursors in the bone marrow; (ii) inflammatory cytokines inhibit the release of erythropoietin (EPO) from the kidney; and (iii) the survival of circulating red cells is shortened.^{[citation needed]}

In the short term, the overall effect of these changes is likely positive: it allows the body to keep more iron away from bacterial pathogens in the body, while producing more immune cells to fight off infection. Almost all bacteria depend on iron to live and multiply. However, if inflammation continues, the effect of locking up iron stores is to reduce the ability of the bone marrow to produce red blood cells. These cells require iron for their massive amounts of hemoglobin which allow them to transport oxygen.^{[citation needed]}

Because anemia of chronic disease can be the result of non-infective causes of inflammation, future research is likely to investigate whether hepcidin antagonists might be able to treat this problem.

Anemia of chronic disease may also be due to neoplastic disorders and non-infectious inflammatory diseases.^[3] Neoplastic disorders include Hodgkin’s disease lung and breast carcinoma and non-infectious inflammatory diseases include rheumatoid arthritis and systemic lupus erythematosus.

Anemia of chronic disease as it is now understood is to at least some degree separate from the anemia seen in renal failure in which anemia results from poor production of erythropoietin, or the anemia caused by some drugs (like AZT, used to treat HIV infection) that have the side effect of inhibiting erythropoiesis. In other words, not all anemia seen in people with chronic disease should be diagnosed as anemia of chronic disease. On the other hand, both of these examples show the complexity of this diagnosis: HIV infection itself can produce anemia of chronic disease, and renal failure can lead to inflammatory changes that also can produce anemia of chronic disease.

Survival advantage

Limiting some microbes' access to iron can reduce their virulence, thereby potentially reducing the severity of infection. Blood transfusion to patients with anemia of chronic disease is associated with a higher mortality, supporting the concept.^[4]

Severity

Anemia of chronic disease is usually mild but can be severe. It is usually normocytic, but can be microcytic.^[3] The presence of both anemia of chronic disease and dietary iron deficiency in the same patient results in a more severe anemia.

Diagnosis

While no single test is reliable to distinguish iron deficiency anemia from the anemia of chronic inflammation, there are sometimes some suggestive data:

In anemia of chronic inflammation without iron deficiency, ferritin is normal or high, reflecting the fact that iron is sequestered within cells, and ferritin is being produced as an acute phase reactant. In iron deficiency anemia ferritin is low.^[3]

TIBC is high in iron deficiency, reflecting production of more transferrin to increase iron binding.; TIBC is low or normal in anemia of chronic inflammation.

Treatment

The ideal treatment for anemia of chronic disease is to treat the chronic disease successfully, but this is rarely possible.

Parenteral iron is increasingly used for anemia in chronic renal disease^[5] and inflammatory bowel disease.^[6]^[7]

Erythropoietin can be helpful, but this is costly and may be dangerous.^[8]^[9] Erythropoietin is advised either in conjunction with adequate iron replacement which in practice is intravenous, or when IV iron has proved ineffective.^[6]^[7]

References

^ Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen BK, Ganz T. (2004). "IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin.". J Clinical Invest. 113 (9): 1251–3. doi:10.1172/JCI20945. PMC 398432. PMID 15124018.
^ Nemeth E, Ganz T. (2006). "Regulation of iron metabolism by hepcidin.". Annu. Rev. Nutr. 26 (1): 323–42. doi:10.1146/annurev.nutr.26.061505.111303. PMID 16848710.
^ ^a ^b ^c Weng, CH; Chen JB; Wang J; Wu CC; Yu Y; Lin TH (2011). "Surgically Curable Non-Iron Deficiency Microcytic Anemia: Castleman's Disease.". Onkologie 34 (8-9): 456–8. doi:10.1159/000331283. PMID 21934347.
^ Zarychanski, R; Houston, DS (Aug 12, 2008). "Anemia of chronic disease: a harmful disorder or an adaptive, beneficial response?". CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 179 (4): 333–7. doi:10.1503/cmaj.071131. PMC 2492976. PMID 18695181.
^ Zager RA (September 2006). "Parenteral iron compounds: potent oxidants but mainstays of anemia management in chronic renal disease". Clin J Am Soc Nephrol. 1 Suppl 1: S24–31. doi:10.2215/CJN.01410406. PMID 17699373.
^ ^a ^b http://chinesefms.com/doc/zhw/doc_zhw_xzzn/201104/P020110416418498436822.pdf
^ ^a ^b http://www.nice.org.uk/nicemedia/live/13329/52853/52853.pdf
^ Anemia of chronic disease at Mount Sinai Hospital
^ Zarychanski R, Houston DS. (2008). "Anemia of chronic disease -- a harmful disorder, or a beneficial, adaptive response?". Can. Med. Assoc. J. 179 (4): 333–7. doi:10.1503/cmaj.071131. PMC 2492976. PMID 18695181.

External links

National Anemia Action Council

UpToDate Contents

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1. 慢性疾患の貧血（［慢性］炎症時の貧血） anemia of chronic disease anemia of chronic inflammation
2. 貧血を有する成人患者に対するアプローチ approach to the adult patient with anemia
3. 血液透析患者での慢性腎疾患における貧血のためのエリスロポエチン erythropoietin for the anemia of chronic kidney disease in hemodialysis patients
4. 透析前および腹膜透析患者における慢性腎疾患の貧血のためのエリスロポエチン erythropoietin for the anemia of chronic kidney disease among predialysis and peritoneal dialysis patients
5. 慢性腎疾患における貧血：エリスロポエチン製剤を投与した患者でのヘモグロビン／ヘマトクリットの目標値 anemia of chronic kidney disease target hemoglobin hematocrit for patients treated with erythropoietic agents

English Journal

Hemolytic anemia and progressive neurologic impairment: think about triosephosphate isomerase deficiency.

Aissa K1, Kamoun F, Sfaihi L, Ghedira ES, Aloulou H, Kamoun T, Pissard S, Hachicha M.
Fetal and pediatric pathology.Fetal Pediatr Pathol.2014 Aug;33(4):234-8. doi: 10.3109/15513815.2014.915365. Epub 2014 May 19.
We have reported the first Tunisian case of triosephosphate isomerase (TPI) deficiency in a 2-year-old girl. She was the first child of a nonconsanguineous couple. The disease included a neonatal onset of chronic hemolytic anemia, recurrent low-respiratory infections then progressive neurological in
PMID 24840153

Physicochemical and structural characterization of iron-sucrose formulations: a comparative study.

Barot BS1, Parejiya PB, Mehta DM, Shelat PK, Shah GB.
Pharmaceutical development and technology.Pharm Dev Technol.2014 Aug;19(5):513-20. doi: 10.3109/10837450.2013.795171. Epub 2013 May 24.
Intravenous polynuclear iron formulations are vital components in the treatment of iron deficiency anemia associated with chronic kidney disease as well as other diseases associated with gastro-intestinal and cardio-vascular system. Intravenous iron preparations consist of iron-carbohydrate nanopart
PMID 23701359

Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias.

Konecny T1, Park JY2, Somers KR3, Konecny D1, Orban M4, Soucek F1, Parker KO2, Scanlon PD2, Asirvatham SJ2, Brady PA2, Rihal CS5.
The American journal of cardiology.Am J Cardiol.2014 Jul 15;114(2):272-7. doi: 10.1016/j.amjcard.2014.04.030. Epub 2014 May 2.
Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality, yet the exact pathophysiological links remain unclear. Whether the presence and severity of COPD are associated with atrial or ventricular arrhythmias recorded on continuous electrocardi
PMID 24878126

Japanese Journal

担癌状態で慢性血液透析療法に導入された患者の生命予後について

原正樹,森戸卓,能木場宏彦,岩佐悠子,安藤稔
日本透析医学会雑誌 47(4), 235-240, 2014
【背景】近年の癌治療の進歩に伴い, 進行した担癌状態の慢性腎臓病 (CKD) 患者に対しても, 透析療法を導入し治療を継続する機会が増加してきた. しかし, こうした担癌患者の慢性透析導入後の予後についての報告は少ない. 【対象と方法】2005年1月から2013年6月までに, 当院でCKDから血液透析 (HD) に導入された担癌患者34例 (男性27例, 女性7例) を対象とした. 臨床病像とデー …
NAID 130003395200

Contrast induced exacerbation of renal dysfunction in the advanced chronic kidney disease

Taniguchi Yousuke,Sakakura Kenichi,Wada Hiroshi [他]
Cardiovascular intervention and therapeutics 28(2), 157-161, 2013-04
NAID 40019634877

心不全患者の日常生活動作に対する左室収縮不全や心腎貧血症候群の影響

齊藤正和,小澤哲也,塩谷洋平,岡村大介,馬淵美也子,中澤麻理子,青柳真理恵,坂本純子,秋保光利
理学療法学 40(1), 10-15, 2013-02-20
【目的】心不全患者の日常生活動作に対する左室収縮不全ならびに心腎貧血症候群に(CRAS)の影響を検討する。【方法】2011年8月から2012年2月の間に入院加療中より理学療法を施行した心不全患者256例(女性49%,年齢79±11歳)を対象とした。入院時の左室駆出率(LVEF)によりHFrEF群(LVEF≦40%)119例とHFpEF群(LVEF > 40%)137例に分類した。また,Hb& …
NAID 110009594478

Related Pictures

★リンクテーブル★

リンク元	「貧血」「慢性疾患による貧血」「ACD」
関連記事	「disease」「chronic」

「貧血」

Anemia of chronic dz
Classification and external resources
ICD-9-CM	285.29
MedlinePlus	000565
eMedicine	emerg/734

　　[★]

英: anemia
同: 貧血症
関: 慢性疾患による貧血 anemia of chronic disease ACD

血液08, 症候 091215I

定義(2007前期生理学プリント、WHOの貧血判定基準)

下記表のHb,Htに達しない場合を貧血とする

	Hb(g/dl)	Ht(%)
男性	13	39
女性	12	36
高齢者・乳幼児・妊婦	11	33

ヘモグロビンと貧血症状

8 g/dl　：急性貧血で症状が出る
7 g/dl　：慢性貧血で症状が出る
5 g/dl　：心雑音
3 g/dl　：生命の危険

病因

臨床検査

貧血を疑ったらMCV(平均赤血球容量)を測定する。

一つの赤血球の平均の大きさが分かる

MCHC(平均赤血球ヘモグロビン濃度)は赤血球に含まれるヘモグロビンの濃度が検査できる

臨床検査に基づく分類

MCV(平均赤血球容量)により３つに分類できる

MCHC(平均赤血球ヘモグロビン濃度)により以下の２つに分類できる

貧血の鑑別 (文献不明)

MCV	赤血球の大きさ	網状赤血球数	腎障害	診断	治療
≦80	小球性貧血			鉄欠乏性貧血	鉄剤
80-100	正球性貧血	減少, 正常	あり	腎性貧血	エリスロポエチン
		減少, 正常	なし	再生不良性貧血	コロニー刺激因子
		増加		溶血性貧血	グルココルチコイド
≧101	大球性貧血			巨赤芽球性貧血	ビタミンB₁₂, 葉酸

スクリーニングによる貧血の鑑別 (OLM.80)

Fe↓、UIBC↑、フェリチン↓：鉄欠乏性貧血、慢性出血、慢性体内溶血。体内での鉄の絶対量が不足
Fe↓、UIBC↓、フェリチン↑：慢性感染症、慢性炎症。細網系では鉄が増加しているが(フェリチン↑)、末梢に鉄を放出できず(Fe↓)、トランスフェリンも減少している(UIBC↓)

身体所見

胸部聴診：収縮期機能性雑音　　←　　どこで聴取される？高心拍出量状態だから心基部か？あるいは心尖部？(100D012)

USMLE

Q book p.292 25

sickle cell anemia	microcytic anemia
beta thalassemia	microcytic anemia
Heinz body anemia	normocytic anemia
hereditary spherocytosis	normocytic anemia
pernicious anemia	macrocytic anemia

貧血と低酸素血症

貧血とは血液中のヘモグロビン濃度が低下した状態であり、一方、低酸素血症は単位体積あたりの酸素分圧が低下してる状態である。PaO2低下すなわちSpO2の低下に相当すると考えてみよう。貧血ではヘモグロビン濃度は少なくても、その少ないヘモグロビンの各々は十分に酸素化されるため、SpO2は低下しない。ただし、ヘモグロビンの絶対量が少ないために、末梢組織に届ける酸素の量が少なくなるだけなのである。(cf. 101B071)

臨床

MCVで検査項目を絞っていくが、病態が複雑な場合はMCVによる絞り込みが意味をなさないことがある。commonな貧血から除外していく。

1. 血算、網状赤血球、フェリチン、鉄、UIBC、葉酸、ビタミンB12
2. 銅、亜鉛
3. 赤沈、血液像
4. 抗核抗体、抗dsDNA抗体、ハプトグロビン、免疫電気泳動(血液)、蛋白分画、IgG,IgA,IgM、C3c、C4、CH50、エリスロポエチン
5. 抗SS-A抗体、抗Sm抗体、ループスアンチコアグラント、抗カルジオ抗体、抗CLGPI抗体、抗RNA抗体、PR3-ANCA、MPO-ANCA、直接クームス検査
6. リンパ球サブセット、PNH(CD55,CD59)