The anemia of chronic disorders: studies of marrow regulation and iron
metabolism
SW Douglas and JW Adamson
Division of Hematology, University of Washington School of Medicine,
Seattle.
Marrow regulation and iron metabolism were evaluated in 17 patients with
mild or moderate anemia associated with chronic disorders. In addition,
whole blood P50 and red cell 2,3-diphosphoglycerate (DPG) levels were
measured. The study group consisted of seven patients with non-hematologic
malignancies, nine with infection or inflammation, and one with idiopathic
hypoproliferative anemia. The mean whole blood P50 and DPG levels were
elevated to 28.5 +/- 1.9 mm Hg and 7.03 +/- 0.83 mumole/ml packed RBC,
respectively, as compared to normal values of 26.6 +/- 0.6 mm Hg and 4.83
+/- 0.33 mumole/ml packed RBC. Erythropoietin (ESF) excretion was variable
(1.1-28.7 IRP U, day), clearly elevated above normal in only three patients
and, within the study group, bore no relation to hematocrit. While nine of
the 17 subjects had ESF excretion rates within the 95% limits predicted by
hematocrit, the remaining eight had lower than expected values. No
significant differences in ferrokinetics, ESF excretion, or hematologic
profile were found between patients with malignancy and those with
inflammation. Marrow transit times correlated inversely with both serum and
urine ESF activity (r = -0.57, p less than 0.02; and r = -0.63, p less than
0.01, respectively), indicating that the marrow reticulocyte release
response to ESF stimulation was unimpaired. Erythroid iron turnovers were
unrelated to serum or urinary ESF activity but were significantly
correlated with serum iron levels expressed as microgram/100 ml whole blood
(r = 0.56, p less than 0.02). These studies suggest that there is an
intraerythrocytic response to the anemia in this group of patients,
document that reduced ESF production is not a uniform finding with the
anemia of chronic disorders, and provide evidence that the marrow
proliferative response to anemia is limited in many patients primarily by
the availability of iron.
Volume 45,
Issue 1,
pp. 55-65,
01/01/1975
Copyright © 1975 by The American Society of Hematology
