The presence of certain chronic medical conditions, such as cancer, and infectious and inflammatory diseases, can lead to the development of anemia. Anemia is a blood disorder occurring when abnormally low levels of red blood cells are found in the blood.

With anemia of chronic disease (ACD), the body cannot effectively use iron to make new red blood cells even though levels of stored iron in the body’s tissue are normal or high. As a result, the number of healthy new red blood cells gradually falls. Similarly, levels of hemoglobin, the component of red blood cells that carries oxygen to the tissues and muscles, also drop. Although ACD is the second most common form of anemia. It is rarely severe.

Causes

Other illnesses contribute to the development of ACD including:

• Chronic infections such as tuberculosis, lung abscess, and subacute endocarditis

• Non-infectious inflammatory diseases such as rheumatoid arthritis, osteomyelitis, systemic lupus erythematosus, and inflammatory bowel disease

• Common childhood infections, including ear infections and urinary tract infections

• Congestive heart failure, thyroid disease, and kidney failure

• Cancer, particularly Hodgkin’s disease, lung cancer, and breast cancer

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 the unusual severe case of ACD, blood transfusions may be helpful. Additionally, drugs that help stimulate growth of new red blood cells, like erythropoietin, may be given temporarily.

Prevention

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

RESOURCES:

Iron Disorders Institute
http://www.irondisorders.org

National Anemia Action Council
http://www.anemia.org

CANADIAN RESOURCES:

Anemia Institute
http://www.anemiainstitute.org

Chronic Disease Management, Government of British Columbia Ministry of Health
http://www.health.gov.bc.ca/cdm/index.html

References:

Beutler E. Unlocking the mysteries of iron homeostasis and of the anemia of chronic disease: is hepcidin the key? Blood. 2003; 102(3):775.

Medline Plus. National Library of Medicine website. Available at http://www.nlm.nih.gov/medlineplus. Accessed July 15, 2005.

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.