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Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 10)

Table 98-6 Diagnosis of Hypoproliferative Anemias Tests Iron Deficiency tion Inflamma Renal Disease Hypometa bolic States Anemia Mild to severe Mild severe Mild to Mild MCV (fL) 90 60– 80–90 90 90 Morphol ogy mo- Nor c Normocyti ytic Normoc Normocytic microcytic SI 360 | Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias Part 10 Table 98-6 Diagnosis of Hypoproliferative Anemias Tests Iron Deficiency Inflamma tion Renal Disease Hypometa bolic States Anemia Mild to severe Mild Mild to severe Mild MCV fL 60- 90 80-90 90 90 Morphol ogy Nor mo- Normocyti c Normoc ytic Normocytic microcytic SI 30 50 Normal Normal TIBC 360 300 Normal Normal Saturatio n 10 10-20 Normal Normal Serum ferritin pg L 15 30-200 115-150 Normal Iron stores 0 2-4 1-4 Normal Note MCV mean corpuscular volume SI serum iron TIBC total iron-binding capacity. Anemia of Renal Disease Chronic renal failure is usually associated with a moderate to severe hypoproliferative anemia the level of the anemia correlates with the severity of the renal failure. Red cells are typically normocytic and normochromic and reticulocytes are decreased. The anemia is primarily due to a failure to produce adequate amounts of EPO and a reduction in red cell survival. In certain forms of acute renal failure the correlation between the anemia and renal function is weaker. Patients with the hemolytic-uremic syndrome increase erythropoiesis in response to the hemolysis despite renal failure requiring dialysis. Polycystic kidney disease also shows a smaller degree of EPO deficiency for a given level of renal failure. By contrast patients with diabetes or myeloma have more severe EPO deficiency for a given level of renal failure. Assessment of iron status provides information to distinguish the anemia of renal disease from the other forms of hypoproliferative anemia Table 98-6 and to guide management. Patients with the anemia of renal disease usually present with normal serum iron TIBC and ferritin levels. However those maintained on chronic hemodialysis may develop iron deficiency from blood loss through the dialysis procedure. Iron must be replenished in these patients to ensure an adequate response to EPO therapy see below . Anemia in Hypometabolic States Patients who are starving .