Contemporary Diagnostic and Therapeutic Possibiliti-
es in Anaemia of Chronic Disease
Ščudla V., Adam Z., Ščudlová M.
III. interní klinika Fakultní nemocnice a LF UP, Olomouc, přednosta prof. MUDr. V. Ščudla, CSc. Interní hematoonkologická klinika Fakultní nemocnice a LF MU Brno, pracoviště Bohunice, přednosta prof. MUDr. J. Vorlíček, CSc. I. interní klinika Fakultní nemocnice a LF UP, Olomouc, přednosta prof. MUDr. J. Lukl, CSc. |
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Summary:
The article deals with contemporary views on anaemia associated with chronic diseases. The
authors present the definition of this nosological unit, draw attention to its high incidence in
clinical practice and fact that it is frequently mistaken for iron deficiency anaemia. The authors
submit a review of the most frequent diseases which cause the development of this type of anaemia and analyze the role of activation of the system of cellular immunity, the monocyte-macrophage system, agents of the cytokine network in inhibition of proliferation and differentiation of
erythroid precursors, reduced production of endogenous erythropoietin with a reduced sensitivity of erythroid progenitor cells to its action and impaired iron homeostasis and inhibition of its
reutilization. Special attention is devoted to diagnostic and differential diagnostic criteria in
relation to other types of anaemia caused by impaired haeme synthesis and some secondary
multifactorially conditioned types of anaemia. More detailed attention is paid to the diagnostic
value of evaluating serum levels of soluble transferrin receptors and explanation of the asset of
calculation of the transferrin receptor/ferririn index as a sensitive indicator of latent sideropenia
as well as the Fe-absorption test using low oral iron doses. Part of the paper is also an account of
contemporary possibilities of treatment including the use of the recombinant form of human
erythropoietin, and attention is drawn to the unsuitability and pitfalls of iron therapy in this type
of anaemia.
Key words:
Anaemia of chronic diseases - Th-1 and Th-2 cytokines -Transferrin receptor/ferritin
index - Fe absorption test - Anaemia due to impaired haeme synthesis - Recombinant human
erthropoietin
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