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anaemia diagnostics at chronic diseases

AHB first of all it is necessary to differentiate with an iron deficiency anaemia (ZHDA) as they often have similar lines. Besides in clinical practice frequently there is combination AHB and ZHDA, that complicates carrying out of differential diagnostics [5].

The basic laboratory indicators are reflected in table 1.2.

Table 1.2.

Differential diagnostics AHB, ZHDA and AHB in a combination with ZHDA

Indicator AHB ZHDA AHB + ZHDA
Serumal iron 4 4 4
Serumal transferrin N or 4 Top border N or f N or 4
Transferrin saturation 4 4 4
Serumal ferritin N or f 4 N or 4
Serumal receptor

tansferrina

N N or f

N - norm

f - the indicator is raised

4 - the indicator is lowered

AHB - normohromnaja, normotsitarnaja an anaemia characterised easy (level of haemoglobin 90-120 g/l) or average (level of haemoglobin 70-90 g/l) severity level. Patients with the given condition have low number of reticulocytes which reflects depression of production of erythrocytes. Diagnostics can be complicated an accompanying hemorrhage, effects from spent therapy, congenital disturbances of synthesis of haemoglobin, such as a thalassemia. In estimation AHB also it is necessary to define the full status of an exchange of iron for the purpose of an exception of an iron deficiency anaemia, which usually
Hypochromia and microcytic. Difference AHB from ZHDA that last is a consequence of deficiency of exclusively iron while AHB - multifactorial [33,150,184].

In both cases, at an anaemia of chronic illnesses and an iron deficiency anaemia, depression of concentration of serumal iron and saturation of a transferrin by iron becomes perceptible, reflecting absolute deficiency of iron at ZHDA and gipoferremiju owing to absorption of iron by reticuloendothelial system at AHB. In case of AHB depression of saturation of a transferrin first of all reflects depression of level of iron of Serum. At ZHDA level of saturation of a transferrin can be even more low because concentration of a transferrin of Serum is raised while transferrin level remains normal or even lowered at AHB [41,82,170,247].

Revealing of a principal cause of deficiency of iron should include the collecting of the anamnesis for an exception of the alimentary reasons. Often deficiency of iron speaks about pathological krovopotere (a polymenorrhea, chronic zheludochnoyokishechnoe a bleeding owing to ulcerative diseases of a gastroenteric tract, inflammatory diseases of an intestine, an angiodysplasia, parasitogenic infections) [42,167].

The ferritin is used as an indicator of stocks of iron and level 15 ng/ml usually specifies in absence of stocks of iron [84,146]. However, at patients with AHB ferritin level normal or is raised, reflecting augmentation of accumulation of iron in reticuloendothelial system, along with rising of level of a ferritin, as ostrofaznogo the squirrel, owing to immune activation [225].

The serumal receptor of a transferrin is the truncated membranous receptor which raises at deficiency of iron when availability of iron to a hemopoiesis is small. Level of soluble receptors of a transferrin at AHB slightly differs from normal, because an expression
Transferrin receptors chokes with inflammatory cytokines. Definition of level of soluble receptors of a transferrin can be necessary for diagnostics AHB with accompanying deficiency of iron. As a rule, such anemias microcytic and more serious. Definition of a parity of concentration of soluble receptors of a transferrin to ferritin level also can be useful to differential diagnostics [30,189,246].

Measurement of level of erythropoetin makes sense only at patients with level of haemoglobin less than 100 g/l as at higher concentration of haemoglobin erythropoetin level remains normal [46]. Besides, at interpreting of results of research of level of erythropoetin at haemoglobin below 100 g/l it is necessary to consider severity level of an anaemia [23,190]. Research of level of erythropoetin is necessary for forecasting of the answer for therapy by preparations of erythropoetin at patients with AHB. After treatment rekombinantnym human erythropoetin (repo) within 2 weeks of patients with a cancer not receiving accompanying chemotherapy at which or erythropoetin level was above 100 Ed/l, or Serum ferritin was above 400 ng/ml absence of effect it became perceptible in 88 % of cases. Such prediktory have not been noted at the patients receiving chemotherapy [69,88,182].

The biopsy of an osteal brain with colouring on Perlsu is spent in unusual cases and in structure of research projects. At RA the normal or raised accumulation of iron in macrophages in a counterbalance to attrition of stocks of iron in erythroblasts and macrophages becomes perceptible at ZHDA [149].

Gepsidin Serums as believe, it can be potentially useful to differential diagnostics AHB and ZHDA at patients with JURA [48]. However its application is limited because of absence referensnyh value and dearness of diagnostic methods.

1.2.3.

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Scientific source EGOROV Andrey Sergeevich. THE GEPSIDIN-INTERLEUKIN-6 SYSTEM AS A FACTOR FOR MANAGING THE COURSE OF ANEMIA IN CHRONIC ARTHRITIS IN CHILDREN DISSERTATION for the degree of candidate of medical sciences. St. Petersburg - 2016. 2016

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