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Anemia of Chronic Disease

(Anemia of Inflammation; Hypoferremia of Inflammatory Disease; ACD)

Definition

Certain long-term medical conditions, such as cancer and infectious and inflammatory diseases, can cause anemia. Anemia is a low level of healthy red blood cells (RBCs). RBCs carry oxygen from the lungs to the rest of the body. When red blood cells are low, the body does not get enough oxygen.
Hemoglobin
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Causes

Anemia has several causes, but some may be unknown. Factors that play into anemia include:
  • Shortened lifespan of red blood cells
  • Reduced production of new red blood cells
  • Reduced secretion of a hormone called erythropoietin, which stimulates red cell production under normal conditions
  • Imbalance or redistribution of iron in the body
Long-term illnesses that can lead to anemia, include:

Risk Factors

Anyone of any age with a chronic inflammatory or infectious disease may be at risk for anemia of chronic disease (ACD), but the elderly are among those at highest risk.

Symptoms

ACD usually develops slowly, producing few or no symptoms. When symptoms do occur, they are usually mild. Symptoms include:
  • Pale complexion, lightheadedness, fatigue, and rapid heartbeat
  • Fever

Diagnosis

You will be asked about your symptoms and medical history, particularly any history of chronic inflammatory or infectious disease or cancer. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:

Treatment

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. These drugs do have risks that are important to consider before using them. There is some evidence that ESAs may shorten survival in people with cancer.

Prevention

If you have a chronic medical condition, continue prescribed treatment and maintain regular visits with your doctor.

RESOURCES

Iron Disorders Institute
http://www.irondisorders.org
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

CANADIAN RESOURCES

Canadian Cancer Society
http://www.cancer.ca
Health Canada
https://www.canada.ca

References

Anemia of inflammation. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115953/Anemia-of-inflammation. Updated May 24, 2016. Accessed September 29, 2017.
Beutler E. Unlocking the mysteries of iron homeostasis and of the anemia of chronic disease: is hepcidin the key? Blood. 2003;102:775.
Explore anemia. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/anemia. Updated May 18, 2012. Accessed September 29, 2017.
Weiss G, Goodnough, LT. Anemia of chronic disease. NEJM. 2005;352(10):1011-1023.
3/12/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T900043/Erythropoiesis-stimulating-agents: 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(8):914-924.
9/2/2009 DynaMed Systematic Literature Plus Surveillance http://www.dynamed.com/topics/dmp~AN~T900043/Erythropoiesis-stimulating-agents: 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.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 09/2017
  • Update Date: 09/29/2017