A n e m i a o f C h r o n i c D i s e a s e
General
• Definition: a mild to moderate anemia accompanying infections,
inflammatory disorders, or malignant diseases (click here to see a list)
that persist more than 1-2 months.
• Second-most-common anemia (after IDA)
• Characterized by hypoferremia, despite abundant macrophage storage iron.
Clinical Features
• Symptoms are those of the underlying disease; anemia is usually mild and
asymptomatic.
• Anemia develops during the first 2 months of the chronic disease; doesn't
progress thereafter.
Pathogenesis
A. Disturbance in iron metabolism (iron never makes it into normoblasts!)
• Mucosal cells absorb iron okay, but don't release it into plasma.
• Macrophages take up iron but release it very slowly.
B. Shortened red blood cell survival
• Cells of patients with ACD have normal lifespan when transfused into
normal patients; but cells of normal patients have shortened lifespan when
transfused into patients with ACD.
• Probably due to increased phagocytosis of red cells by macrophages.
C. Impaired bone marrow response to anemia
• Not enough iron available to make adequate numbers of red blood cells.
• Not enough erythropoietin around, and bone marrow can't respond to what
little there is.
Morphology
• Normochromic, normocytic anemia (usually); may be hypochromic,
microcytic (MCV rarely falls below 72 fL).
• No significant anisocytosis and poikilocytosis.
Iron studies
• Decreased serum iron
• Decreased TIBC (total iron binding capacity)
• Decreased transferrin saturation
• Increased ferritin (remember though: ferritin is an acute phase reactant!)
• Increased bone marrow storage iron
Diagnosis
• Usually symptoms of underlying chronic disease will be present.
• Mild, usually normochromic, normocytic anemia.
• Abnormal iron studies (see above).
Treatment
• Treat underlying disease!
• ACD is usually so mild that treatment of anemia is not required.
