Iron Deficiency Anemia in Adult Onset Still's Disease with a Serum Ferritin of 26,387 μg/L.
Iron Deficiency Anemia in Adult Onset Still's Disease with a Serum Ferritin of 26,387 μg/L.
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作者：
Patel S;Monemian S;Khalid A;Dosik H
血清铁蛋白在慢性炎症的贫血中升高，反映了铁储存增加和其他炎症介导的变化。当铁缺乏共存时，铁蛋白可能并不总是下降到低于正常范围。我们描述了罕见的铁缺乏与极端高铁蛋白血症的相互作用，这是成人斯蒂尔病的特点。这一组合具有临床意义，即使存在明显的铁缺乏，也可以减少26,387 μg/L的血清铁蛋白的存在。当斯蒂尔病缓解，血清铁蛋白降至6.5 μg/L时，缺铁性贫血的诊断延迟并完全显露。在评估慢性炎症性贫血患者时，即使铁蛋白水平升高几百倍，也应考虑缺铁的共存。斯蒂尔病急性期患者的大量高铁蛋白血症几乎完全是无铁的载铁蛋白形式，这一可能性表明了对斯蒂尔病铁蛋白代谢的进一步了解。
Serum ferritin rises in the anemia of chronic inflammation reflecting increased iron storage and other changes mediated by inflammation. When iron deficiency coexists, the ferritin may not always decline into the subnormal range. We describe the rare interaction of iron deficiency with the extreme hyperferritinemia characteristic of adult onset Still's disease. The combination has clinical relevance and allows deductions about the presence of serum ferritin at 26,387 μg/L despite obvious iron depletion. The diagnosis of iron deficiency anemia was delayed and became fully obvious when her Still's disease remitted and serum ferritin decreased to 6.5 μg/L. The coexistence of iron deficiency should be considered when evaluating a patient with anemia of chronic inflammation even when the ferritin level is elevated several hundredfold. Further insights on ferritin metabolism in Still's disease are suggested by the likelihood that the patient's massive hyperferritinemia in the acute phase of Still's disease was almost entirely of the iron-free apoferritin form.