Anemia of chronic disease is the second most common form of anemia when world statistics are analyzed.
There is a lack of available iron in the bone marrow as a result of a systemic inflammation, a chronic infection or due to cancer. Often a chronic illness is associated with iron deficiency as well. There is a combination of several factors that lead to this form of anemia. Measurements of red blood cell (RBC) survival show that RBC’s live shorter than the normal 120 days. The production of new RBC’s in the bone marrow (called erythropoiesis) is reduced because of a relative shortage of the RBC producing hormone, erythropoietin, and because the bone marrow is less responsive to it. In addition the intracellular metabolism of iron is suppressed. The end result is that the bone marrow cannot compensate for the anemia by increase RBC production, because of the combination of reduced erythropoietin production and impaired iron metabolism.
Again there are the general symptoms of lassitude, lack of energy and other symptoms described in the introductory chapter to anemia. On top of this there are the symptoms associated with the underlying chronic disease.
Blood tests include tests of transferrin, transferrin receptor, serum ferritin and hemoglobin. Details of these tests have to be discussed with the doctor. Often a referral to a hematologist is necessary.
The underlying chronic disease needs to be treated to be successful with the treatment of the anemia of chronic disease. Blood transfusions are rarely needed. Instead recombinant erythropoietin is given. As both production and bone marrow sensitivity to erythropoietin are reduced, a higher dose is required. Typically 150 to 300 units per kilogram are given subcutaneously three times per week. A patient who had an initial hemoglobin of 8.0 micrograms/deciliter and who responded with an increase to 8.5 micrograms/deciliter or higher, is considered to have had a good response. Additionally, iron supplements have to be given to increase the responsiveness of the bone marrow to erythropoietin.
1. Merck Manual (Home edition): Anemia
2. Noble: Textbook of Primary Care Medicine, 3rd ed., Mosby Inc. 2001
3. Goldman: Cecil Medicine, 23rd ed., Saunders 2007: Chapter 162 – APPROACH TO THE ANEMIAS