Ease Into Prep with a PANCE^® Question of the Day

The correct answer is A. The anemia of chronic disease is seen in patients who have underlying severe chronic disorders such as infections, inflammatory diseases (such as this patient's rheumatoid arthritis), and cancers. The anemia is usually initially normocytic but may with time become microcytic. Factors contributing to the anemia can include shortening of the erythrocyte life span, inadequate erythropoietin production or impaired response to erythropoietin, and alterations in iron metabolism. If iron deficiency has not yet also developed, serum ferritin levels are usually high in anemia of chronic disease. This can be helpful in distinguishing the microcytic form of anemia of chronic disease from iron deficiency anemia.

Macrocytes (choice B) suggest vitamin B12 or folate deficiency.

Spherocytes (choice C) suggest hereditary spherocytosis.

Target cells (choice D) suggest thalassemia.

Tear drop forms (choice E) suggest myelophthisic anemia.

PEARL: Anemia of chronic disease is caused by an inflammation-mediated reduction in red blood cell production , and the underlying inflammatory process also results in decreased length of survival of the red blood cells that are made. There is either a normochromic, normocytic anemia or microcytic, hypochromic anemia with a relatively low corrected reticulocyte count, low serum iron, low TIBC (in contrast to iron deficiency states), low transferring saturation, and elevated serum ferritin levels (not an iron problem). The peripheral smear is normal. Anemia of chronic disease can be caused by collagen vascular and autoimmune disease, chronic infection, acute infection, malignancy, and chronic illness.