Anemia of Chronic Disease
(Anemia of Inflammation; Hypoferremia of Inflammatory Disease; ACD)
The presence of certain chronic medical conditions, such as cancer
With anemia of chronic disease (ACD), the body cannot effectively use iron to make new red blood cells, even though levels of stored iron in the body’s tissue are normal or high. As a result, the number of healthy new red blood cells gradually falls. Similarly, levels of hemoglobin, the component of red blood cells that carries oxygen to the tissues and muscles, also drop. Although ACD is the second most common form of anemia, it is rarely severe.
Other illnesses contribute to the development of ACD, including:
- Chronic infections, such as tuberculosis
Anyone of any age with a chronic inflammatory or infectious disease may be at risk for ACD, but the elderly are among those at highest risk.
ACD usually develops slowly, producing few or no symptoms. When symptoms do occur, they are usually mild. Symptoms include:
- Pale complexion, dizziness, fatigue, and rapid heartbeat
- Infection, fever (even mild)
Your doctor will ask about your symptoms and medical history, particularly any history of chronic inflammatory or infectious disease or cancer, and perform a physical exam. Blood tests may include:
- Red blood cell count
- Hemoglobin level
- Serum iron level
- Serum ferritin level
- Serum transferrin receptor level
- Transferrin iron binding capacity
- Total iron binding capacity (TIBC)
Because iron stores will be elevated in the bone marrow, a bone marrow biopsy may also be performed.
With ACD, if the underlying disease causing it is found and treated, the anemia may improve or clear on its own. Iron supplements and vitamins are generally not effective.
For severe cases of ACD, blood transfusions
Iron Disorders Institute
National Anemia Action Council
Canadian Cancer Society
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Weiss G, Goodnough, LT. Anemia of chronic disease. NEJM. 2005;352:1011-1023.
3/12/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Bennett CL, Silver SM, Djulbegovic B, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA. 2008;299:914-924.
9/2/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Bohlius J, Schmidlin K, Brillant C, et al. Erythropoietin or Darbepoetin for patients with cancer—meta-analysis based on individual patient data. Cochrane Database Syst Rev. 2009;(3):CD007303.
Last reviewed November 2009 by
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