Anaemia of Chronic Disease

  • Commonly occurs in chronic disease

Causes

Chronic infections

  • osteomyelitis

  • bacterial enodcarditis

  • tuberculosis

  • chronic abscesses

  • bronchiectasis

  • chronic urinary tract infections

  • HIV /AIDS

  • malaria

Chronic inflammatory disorders

  • rheumatoid arthritis

  • polymyalgia rheumatica

  • systemic lupus erythematosus

  • scleroderma

  • inflammatory bowel disease

  • thrombophlebitis

Malignant diseases

  • carcinoma

    • especially metastatic or associated with infection

  • lymphoma

Other

  • congestive heart failure

  • ischaemic heart disease

Laboratory findings

  • normocytic or mildy microcytic

  • normochromic or mildly hypochromic

  • Moderate anaemia (>9g/dl)

  • Reduced serum iron and total iron binding capacity

  • Normal or raised serum ferritin

  • adequate iron stores in bone marrow, stainable iron absent from erythroblasts

Pathogenesis

Increased cytokines (IL-1,IL-6,TNF, IFN-gamma) leading to

  • reduced release of iron
  • reduce erythropoeisis
  • reduced iron utilisation
  • reduced response to erythropoeitin

Treatment

  • treat underlying condition
  • recombinant erythropoeitin - e.g.
    • rheumatoid arthritis
    • cancer
    • myeloma
 

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