Inflammatory anemia in pediatric patients

Inflammation is the second most common cause of anemia in children after ir on deficiency. Causes of inflammatory anemia include inflammatory diseases, chronic infections, and malignancies. Serum iron levels are low, whereas s erum ferritin is normal or high as a result of preferential routing of seru m iron toward iron stores. The reticulocyte count is low. Laboratory tests show inflammation, which is often severe. The mechanisms underlying inflamm atory anemia have been partly elucidated by research demonstrating that inf lammatory cytokines can inhibit several stages of the erythropoietic proces s. Among these cytokines, interleukin-1, tumor necrosis factor, and interfe ron gamma are released in large amounts during inflammatory syndromes and a ct on the macrophage, which is at the heart of the inflammatory process. Th e erythrocyte life span is shortened. Although iron stores are inflated the ir availability for hemoglobin biosynthesis is reduced. Erythropoietin prod uction is inadequate and the bone marrow response to erythropoietin is dimi nished. The main differential diagnosis is iron deficiency. Serum ferritin assay is the parameter that allows to distinguish between these two conditi ons, thus avoiding unnecessary long-term iron supplementation. The outcome of inflammatory anemia is closely correlated with that of the causative dis ease.