Anemia of Chronic Disease
En Español (Spanish Version)

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 (RBC). 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. This can cause symptoms such as fatigue, pale skin, or irregular heartbeat.

Hemoglobin

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Causes
Certain illnesses will prompt your body to limit how much iron is freely available. This will prevent the infection or cancer from using the iron to grow. Unfortunately, iron is also needed to make healthy RBCs. Over time this will lead to fewer new red blood cells.

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 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, dizziness, fatigue, and rapid heartbeat
  • Infection, fever (even mild)

Diagnosis
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.

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. 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.

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




RESOURCES:
Iron Disorders Institute

National Anemia Action Council

CANADIAN RESOURCES:

Canadian Cancer Society

References:
Anemia. Mayo Clinic.com website. Available at: http://www.mayoclinic.com/health/anemia/DS00321 . Updated March 2009. Accessed December 13, 2010.

Beutler E. Unlocking the mysteries of iron homeostasis and of the anemia of chronic disease: is hepcidin the key? Blood . 2003;102:775.

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 http://www.ebscohost.com/dynamed/what.php : 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 http://www.dynamicmedical.com/what.php : 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 September 2013



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