A Patient With End- Stage Renal Disease Is Evaluated For Shortness Of Breath

A patient with end-stage renal disease complains his doctor about shortness of breath on slight exertion and even sometimes at rest. After dialysis , he is found to have a hematocrit of 28 (normal 37-42) and a MCV of 68 (normal 80 -100). His peripheral blood smear is shown below:

Hypochromic, microcytic cells.

Iron studies are performed which shows normal Iron, normal Total iron binding capacity and normal Ferritin. What is the most likely Diagnosis?
.
.
Anemia Of Chronic Disease.

Case Discussion: 
Anemia of chronic disease is an anemia that is found in patients suffering from certain long term medical conditions like Rheumatoid arthritis, end stage renal disease, chronic, infectious or inflammatory connective tissue disease.

Clinical features: Early during the disease anemia may be mild with almost no symptoms. Later on patients may complain of shortness of breath, fatigue. headache and pallor.

Diagnosis: Along with a history of a chronic medical condition, anemia of chronic disease can be distinguished from iron deficiency anemia by performing iron studies.

• In anemia of chronic disease : Ferritin is normal or high, while in iron deficiency anemia ferritin is low.
• Total iron binding capacity is high in iron deficiency anemia, reflecting the production of more transferrin to increase iron binding, TIBC is normal or low in anemia of chronic disease. 

Treatment: Ideal treatment is correction and treatment of underlying chronic medical condition which is sometime difficult. 

Erythropoietin is helpful , especially in patients with end stage renal disease.