Anemia of chronic disease

anemia due to chronic inflammation

second most common anemia

inflammation → increase in cytokines (esp. IL-6) and hepcidin → results in the outcomes listed below:

• Reduced iron release from macrophages in the reticuloendothelial system and reduced intestinal iron absorption → reduced iron available systemically

• Reduced response (of production) to erythropoietin (EPO) and relative reduction of EPO levels → reduced RBC synthesis

• Reduced erythrocyte survival and lifespan

• Inflammation (e.g., rheumatoid arthritis, systemic lupus erythematosus)

• Malignancy (e.g., lung cancer, breast cancer, lymphoma)

• Chronic infections (e.g., tuberculosis)

• CBC: normocytic anemia (early phase) → microcytic anemia (later phase)

• Low iron

• Low iron saturation

• Low total iron binding capacity (TIBC)

• High serum ferritin

• Low reticulocyte count

• Treat the underlying cause

• Blood transfusion if required (see transfusion for indications for blood transfusion)

• EPO in chronic incurable diseases (e.g., chronic kidney disease)