Anemia of Inflammation & Chronic Disease

So normally, if you eat red meat, red meat contains heme iron and heme iron is well absorbed which has around 25% of absorption rate but if you are vegetarian, then you eat plant products and these food are normally contain non-heme iron. Non-heme iron is less well absorbed, so normally has less than 10% iron absorption rate. So red meat and also like a shellfish, seafood or eggs. They can also give you heme iron and non-heme iron and plants are give us non-heme iron. So our dry fruits or dry vegetables like raising, dry apricot ,red date, these give a high amount of iron per hundred grams weight.

And other fresh fruits like dragon fruit, kiwi and also passion fruit, they also contain high amount of iron. Another one is like a legume like red bean or kidney bean, also like whole grants, nuts, they also give us a high amount of iron. Also like roots vegetable like beetroots or seaweeds, they also provides a good iron. So now you may guess which red meat contains higher amount of iron? And the answer is duck meat. It provides almost 3.8 mg iron/100 g. The second is goose meat, so this give us around 1.9 mg iron/100 g. Then after that is steak. Steak, especially the leg of beef contains around 3 mg iron/100 g.

And this is also the same for pork leg, so pork leg have around 1.3 mg iron/100 g. So normally pork and the lamb have very similar amount of iron. Because Acids helps non-heme iron being absorbed in the gut, so you should eat Vitamin C-rich foods at every meal and don’t drink coffee or tea during or immediately after a meal. Now we move on to pathophysiology of iron metabolism related to obesity. So you may say, “oh I’m a meat-eater, why I still get iron deficiency anemia?” so anemia of information or sometimes it called anemia of is characterized by hypoferremia that means low serum iron. and also increased serum hepcidin and inflammation.

So anemia of information is associate with patients with severe obesity. or chronic disease like cancer, infection, or metabolic syndrome. Major difference between iron deficiency anemia and anemia of inflammation is that iron deficiency anemia is due to the insufficient iron intake and normally and normally this is associate with malnutrition. Whereas anemia of inflammation is normally patients have sufficient iron intake and is because the increased inflmmation that caused iron has been withheld from erythroid precursors. And in this case, this type of anemia is called a anemia of inflammation. So information can trigger hepcidin synthesis. Hepcidin is the principal regulator of systemic iron homeostasis.

Ferroportin is the sole known cellular iron exporter in mammals It’s proposed by Elizabeth Nemeth and Thomas Ganz, hepcidin controls plasma iron concentration by physically binding to ferroportin. And this will lead to ferroportin degradation and blockage of dietary iron absorption and cellular iron release to plasma. So overall, if you have increased inflammation in your body and this will activate hepcidin synthesis in the liver. Hepcidin can regulate ferroportin, so high hepcidin with great ferroportin And in this case, the storage iron in the liver is unable to release to the plasma. So chronically, this patient may have iron retention in the liver or other parts of the organs. and because iron is unstable so excess iron can also triggers tissue injury.

Hepcidin can also control iron absorption rate in the small intestine so high hepcidin again will decrease ferroportin and so in this case, this will leads to the decreased iron absorption rate. So overall, if you have increased hepcidin in your body and this will leads to the low iron absorption rate. And also, the storage iron in your body is unable to release. So chronically, these patients may have low a plasma iron and when the plasma iron is too low aren’t to supply enough iron in the bone marrow then patients would have anemia of inflammation. So this slide is the liver biopsy slide from patients with hepatitis C.

And you can see the yellow patch is the cirrhosis and the blue particles you see is the iron precipitation. On this slide is from patients with hepatitis C and you can see a massive iron precipitation in the liver as well. And this is also same for a liver biopsy from hepatitis B virus infection patients