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Analysis

Anemia of chronic disease: A harmful disorder or an adaptive, beneficial response?

Ryan Zarychanski and Donald S. Houston
CMAJ August 12, 2008 179 (4) 333-337; DOI: https://doi.org/10.1503/cmaj.071131
Ryan Zarychanski MD
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Donald S. Houston MD PhD
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    Figure 1: In inflammatory diseases, cytokines released by activated leukocytes and other cells exert multiple effects that contribute to the reduction in hemoglobin levels: (A) Induction of hepcidin synthesis in the liver (especially by interleukin-6 [IL-6], along with endotoxin). Hepcidin in turn binds to ferroportin, the pore that allows egress of iron from reticuloendothelial macrophages and from intestinal epithelial cells. Binding of hepcidin leads to internalization and degradation of ferroportin; the corresponding sequestration of iron within the macrophages limits iron availability to erythroid precursors. (B) Inhibition of erythropoietin release from the kidney (especially by interleukin-1β [IL-1β] and tumour necrosis factor α [TNFα]). Erythropoietin-stimulated hematopoietic proliferation is in turn reduced. (C) Direct inhibition of the proliferation of erythroid progenitors (especially by TNFα, interferon-γ [IFNγ] and IL-1β). (D) Augmentation of erythrophagocytosis by reticuloendothelial macrophages (by TNFα). RES = reticuloendothelial system.. Image by: Lianne Friesen and Nicholas Woolridge

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Canadian Medical Association Journal: 179 (4)
CMAJ
Vol. 179, Issue 4
12 Aug 2008
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Anemia of chronic disease: A harmful disorder or an adaptive, beneficial response?
Ryan Zarychanski, Donald S. Houston
CMAJ Aug 2008, 179 (4) 333-337; DOI: 10.1503/cmaj.071131

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Anemia of chronic disease: A harmful disorder or an adaptive, beneficial response?
Ryan Zarychanski, Donald S. Houston
CMAJ Aug 2008, 179 (4) 333-337; DOI: 10.1503/cmaj.071131
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  • Physiological and pathological population dynamics of circulating human red blood cells
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  • Effect of anemia and comorbidity on functional status and mortality in old age: results from the Leiden 85-plus Study
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