Anemia of Chronic Disease
(Anemia of Inflammation; Hypoferremia of Inflammatory Disease; ACD)
The presence of certain chronic medical conditions, such as cancer]]> and infectious and inflammatory diseases, can lead to the development of anemia. ]]>Anemia]]> is a blood disorder occurring when blood has abnormally low levels of red blood cells.
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]]>, lung abscess, and subacute ]]>endocarditis]]>
- Noninfectious inflammatory diseases, such as ]]>rheumatoid arthritis]]>, ]]>osteomyelitis]]>, ]]>systemic lupus erythematosus]]>, and ]]>inflammatory bowel disease]]>
- Common childhood infections, including ]]>ear infections]]> and ]]>urinary tract infections]]>
- ]]>Congestive heart failure]]>, thyroid disease, and ]]>kidney failure]]>
- Cancer, particularly ]]>Hodgkin’s disease]]>, ]]>lung cancer]]>, and ]]>breast cancer]]>
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]]> may be necessary. Another treatment is to give erythropoiesis-stimulating agents (ESAs), which help stimulate growth of new red blood cells. Examples of ESAs include ]]>epoetin]]> and ]]>darbepoetin]]>. These drugs do have risks that are important to consider before using them. There is some evidence that ESAs may shorten survival in cancer patients.
Iron Disorders Institute
National Anemia Action Council
Canadian Cancer Society
Beutler E. Unlocking the mysteries of iron homeostasis and of the anemia of chronic disease: is hepcidin the key? Blood. 2003;102:775.
Medline Plus. National Library of Medicine website. Available at http://www.nlm.nih.gov/medlineplus. Accessed July 15, 2005.
Merck Manual of Medical Information, Second Home Edition Online. Merck and Co, Inc. website. Available at http://www.merck.com/mmhe/index.html. Accessed July 15, 2005.
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 ]]>Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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