The following data refer to a patient admitted to ICU with septic shock on a background of active rheumatoid arthritis.
Parameter |
Patient Value |
Adult Normal Range |
Haemoglobin |
86 g/L* |
125 – 180 |
Serum ferritin |
298 µg/L |
15 – 300 |
Serum iron |
7 µmol/L* |
9 – 27 |
Total Iron Binding Capacity (TIBC) |
52 µmol/L |
47 – 70 |
Transferrin Saturation (Iron / TIBC x 100) |
28% |
16 – 40 |
Erythropoietin level |
15 U/L |
4 – 28 |
C-reactive protein (CRP) |
321 mg/L* |
< 8 |
a) State the abnormality demonstrated in this patient? Give your reasoning. (20% marks)
b) State the pathogenesis of these changes? (20% marks)
c) State the principles of management? (10% marks)
Very well answered, with most candidates demonstrating the ability to interpret and discuss anaemia. Many candidates omitted EPO and conservative treatment for iron-deficiency anaemia in the management part of the question. Poorer answers did not identify the cause of anaemia correctly.
a)
So, this patient has
So: this is a classical picture seen with anaemia of inflammation.
b)
The mechanism of this is as follows:
c)
Management consists of controlling the inflammation and transfusing red cells. Erythropoiesis will usually not respond to iron infusion (and anyway there's plenty of iron stores) and there is usually no added benefit from EPO.
Nemeth, Elizabeta, and Tomas Ganz. "Anemia of inflammation." Hematology/Oncology Clinics 28.4 (2014): 671-681.
Hawkins, Stephen F., and Quentin A. Hill. "Diagnostic Approach to Anaemia in Critical Care." Haematology in Critical Care: A Practical Handbook (2014): 1-8.