anemia of chronic disease
Introduction
Introduction to anemia of chronic diseases Chronic disease anemia refers to some chronic infections such as tuberculosis, lung abscess, inflammation, such as rheumatoid arthritis, systemic lupus erythematosus and inflammatory bowel disease, such as breast cancer, malignant lymphoma, etc. - Anemia associated with 2 months later, characterized by low serum iron, low total iron binding capacity, and anemia with increased iron storage. basic knowledge The proportion of illness: 0.02% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia, gastric cancer, colon cancer
Cause
Anemia cause of chronic diseases
Cause:
It is different from anemia caused by other systemic diseases, such as liver disease, kidney disease and anemia caused by endocrine diseases. The mechanism of its occurrence is not very clear. At present, the following aspects are considered: (1) the life span of red blood cells is shortened; Bone marrow response to anemia; (3) iron release and utilization disorders; (4) mental factors subjectively abnormal, attention turned to itself. Healthy people focus on work or study, and psychological activities often point to external objective things.
Prevention
Anemia prevention for chronic diseases
The following prevention content is for reference only:
The first advocate of breastfeeding: because the bioavailability and absorption rate of iron in breast milk are higher than milk; after 4 months, egg yolk, liver mud, minced meat, soy flour, boiled vegetables and other iron-containing complementary foods should be added; milk Feeding children should be added earlier than 2-3 months. The daily iron requirement in children is 10-15 mg, and the adolescent girl is 20 mg per day. When the iron content of the food provided every day does not meet this requirement, it should be Ingestion of iron supplements.
The second is to master the scientific feeding skills: the food to be supplied must be combined with the characteristics of children's age, digestive function, etc. The nutrients should be complete, the amount and proportion should be appropriate, the food should not be too fine, too much sugar, too greasy, the condiment is too strong and It is irritating, its variety should be diversified, don't destroy nutrients during cooking, and it is good in color, fragrance and taste to increase the appetite of children.
The third is to eat more fresh vegetables, fruits and vegetables: fruits and other rich in vitamin C, help the absorption of iron in food, because each food can not supply all the nutrients necessary for people, so the diet must be balanced.
Fourth, correct some bad eating habits: such as coercion, temptation to eat and picky eaters, partial eclipse, and thoroughly treat various chronic hemorrhagic diseases.
Complication
Anemia complications of chronic diseases Complications, anemia, gastric cancer, intestinal cancer
Anemia caused by malignant tumor
Malignant tumors, especially most solid tumors, are more prevalent in older people than younger adults. Because the elderly have anemia, they must be highly alert to the presence or absence of malignant tumors. Sometimes, anemia can be the first symptoms of malignant tumors, such as stomach cancer and intestinal cancer.
The mechanism of anemia caused by malignant tumors is similar to the mechanism of anemia caused by chronic infection, which is an obstacle to iron utilization. Other factors are: 1 cancer cells metastasized to the bone marrow and affect the normal hematopoietic mechanism, which is called bone marrow anemia; 2 tumor cell growth block or digestive tract tumor causes nutrient absorption disorder, leading to dystrophic anemia with insufficient hematopoietic raw materials; 3 tumor itself such as digestive tract tumor caused by chronic blood loss in the gastrointestinal tract; 4 radiotherapy, chemotherapy on the hematopoietic system, the elderly due to low bone marrow function, poor tolerance to radiotherapy, chemotherapy, prone to bone marrow suppression; 5 elderly cancer patients Low immune function, easy to cause infection and lead to anemia; 6 in the blood vessels narrowed by cancer cell invasion, or due to the release of tissue coagulation factors from tumor tissue, disseminated intravascular coagulation (DIC) can form a fibrin network, making red blood cells It is blocked and broken when traveling, and microvascular hemolytic anemia occurs.
Renal anemia
It is an anemia caused by deterioration of kidney disease leading to renal failure or uremia, which is one of the early characteristics of uremia. When urea nitrogen is greater than 17.9 mmol/L and creatinine is greater than 354 mol/L, anemia almost inevitably occurs. Can be seen in chronic pyelonephritis, chronic diffuse glomerulonephritis, visible in diabetic nephropathy, renal cysts, renal tuberculosis, renal arteriosclerosis, metabolic abnormalities and hemodynamic disorders caused by decreased glomerular filtration rate. Some patients found anemia in the above-mentioned disease examination, and some found nephritis failure due to anemia examination. This type of anemia is more common in elderly anemia. Its pathogenesis is: 1 due to renal endocrine dysfunction, erythropoiesis (EPO) production disorders and red blood cell production, which is the main cause of nephrotic anemia, 2 metabolic abnormalities, retention of metabolites inhibit erythropoiesis and differentiation And damage the end of red blood cells, shorten their lifespan, 3 myelodysplastic, 4 uremia, fasting, diarrhea and easy bleeding can cause iron deficiency, folate deficiency and protein deficiency, loss of protein in urine, especially transport iron Loss of protein is also easy to cause anemia; 5 uremia patients often have various bleeding and cause chronic blood loss.
Symptom
Anemia symptoms of chronic diseases Common symptoms neutropenia, dizziness, palpitations, fatigue, pale
The clinical manifestations are mainly mild to moderate anemia, hemoglobin is rarely less than 90g / L, HCT is not less than 32%, is positive cell positive pigment anemia, about 1/3 ~ 1/2 patients show low pigment or small cells Anemia, patients with serum iron and total iron binding capacity are lower than normal, iron saturation is normal or less than normal, serum ferritin is increased, red blood cell free protoporphyrin is also increased, iron myelocytes in bone marrow are reduced and macrophages Increased storage iron.
Examine
Examination of anemia of chronic diseases
Hemoglobin is rarely less than 8g/dl.
Determination of serum ferritin and transferrin receptor, if there is iron deficiency in addition to anemia of chronic disease, serum ferritin does not increase (generally maintained at <100ng/ml); serum ferritin in infection, inflammation or cancer Low level.
Diagnosis
Diagnosis and diagnosis of anemia of chronic diseases
diagnosis
The World Health Organization (WHO) standards are HGB below 130 g/L (male) and 120 g/L (female). There is no uniform standard for anemia in the elderly over 60 years old in China. In view of the fact that the red blood cell count and hemoglobin concentration of the elderly are not much different between men and women, it is considered that RBC <3.5×10 12 /L, HGB<110g/ L, HCT <0.35 is more suitable as a standard for anemia in the elderly.
Differential diagnosis
The disease needs to be differentiated from other types of anemia, such as thalassemia, anemia caused by excessive hemolysis, anemia caused by folic acid deficiency, iron deficiency anemia, etc. In addition to the symptoms of anemia, the disease also has symptoms of primary disease.
