Anemia of chronic disease: Causes, Symptoms, Diagnosis and Treatment

Anemia of chronic disease is a type of anemia that occurs alongside a longstanding disease or inflammation. It starts as normocytic and as time passed it becomes microcytic hypochromic anemia. In this article we will delve into its symptoms, causes, and treatment.


◉ What is Anemia of Chronic Disease

Anemia of chronic disease, also know as anemia of inflammation, occurs when there's an autoimmune illness or any other chronic illness that lasts over three months and causes long standing inflammation.

Anemia of chronic inflammation is a response to the body dealing with persistent inflammation. Chronic inflammation affects the body's ability to utilize the iron needed to make adequate amount of red blood cells, impairing their function and causing anemia.

Treatment of anemia of chronic disease automatically happens by treating the underlying condition. Sometimes erythropoietin is administered to accelerate the treatment process.



◉ Pathophysiology

This type of anemia occurs as part of a chronic inflammatory disorder, a process that can begin during infection, inflammation, trauma, critical illness, or after surgery.

Here are four pathophysiological mechanisms known to be the cause:

◉ Causes

Many diseases can cause anemia of chronic disease, here is a list of some of them:

◉ Symptoms and signs

The severity of symptoms may vary depending on the chronic disease involved and the degree of anemia.

It's essential to note that these symptoms are nonspecific and may be indicative of various health issues. Further examination and medical evaluation are necessary for an accurate diagnosis and appropriate management.

◉ Diagnosis and laboratory tests

The initial diagnosis is made by obtaining a thorough medical history from the patient, followed by general investigations to exclude other types of anemia. It is crucial during the investigation to differentiate between anemia of chronic disease, iron deficiency anemia, and other causes of hypochromic and microcytic anemia.

Laboratory findings in Anemia of Chronic Disease

Blood film: it may provide information of underlying causes of anemia of chronic disease for example it may show thrombocytosis in case of chronic hemorrhage, neutrophils containing toxic granules in sever sepsis or hyper-segmented neutrophils in mixed nutritional deficiency or vitamin B12 deficiency/folate deficiency.

◉ Treatment

Main aim of treatment is treatment of underlying cause of anemia to relieve its symptoms. People who have anemia caused by cancer or chronic kidney disease or autoimmune disease may need additional treatment. The available treatment options are:

The treatment of anemia of chronic inflammation may include:

◉ Conclusion

Anemia of chronic disease happens due to longstanding infections, autoimmune conditions and malignancies as a result of numerous inflammatory factors such as hepcidin, and the main line of treatment is to primarily correct the underlying condition, but in severe cases red blood cell transfusions and erythropoietin injections can be given.


Reference

  1. Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019 Jan 3;133(1):40-50. doi: 10.1182/blood-2018-06-856500. Epub 2018 Nov 6. PMID: 30401705; PMCID: PMC6536698.
  2. Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Med Princ Pract. 2017;26(1):1-9. doi: 10.1159/000452104. Epub 2016 Sep 28. PMID: 27756061; PMCID: PMC5588399.
  3. Anemia - Symptoms and causes - Mayo Clinic. (2023, May 11). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360
  4. Professional, C. C. M. (n.d.). Anemia of chronic disease. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14477-anemia-of-chronic-disease
  5. Gerber, G. F. (2023, December 8). Anemia of renal disease. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/hematology-and-oncology/anemias-caused-by-deficient-erythropoiesis/anemia-of-renal-disease
  6. De Las Cuevas Allende, R., De Entresotos, L. D., & Díez, S. (2021). Anaemia of chronic diseases: Pathophysiology, diagnosis and treatment. Medicina Clínica (English Edition), 156(5), 235–242. https://doi.org/10.1016/j.medcle.2020.07.022