History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include autoimmune disorders; malignancy; acute or chronic infection; critical illness, major trauma, or major surgery with delayed recovery; chronic disease.
systemic symptoms of underlying condition
Symptoms such as fever, night sweats, anorexia, weight loss, weakness, myalgias, or arthralgias should prompt a search for an underlying condition.
absent history of bleeding
It is important to determine if symptoms of bleeding are present (e.g., melaena, haematochezia, menorrhagia, metrorrhagia). Bleeding is not expected in anaemia of chronic disease and should prompt a different workup.
physical finding suggesting infection
This might include symptoms such as neck stiffness; joint tenderness; abdominal, chest, or bone pain; and site-specific signs of infection (e.g., decreased breath sounds or sticky rales).
Any non-trivial infection may cause anaemia of chronic disease.
physical finding suggesting neoplasm
Including the presence of a mass, lymphadenopathy, hepatomegaly, splenomegaly.
Any active neoplasm may cause anaemia of chronic disease.
physical finding suggesting autoimmune disorder
This might include tenderness of the joints or shoulder girdle, or the presence of a rash.
Other diagnostic factors
common
absent history of high alcohol intake
Although a positive history may be present in people with anaemia of chronic disease, it may prompt consideration of an alternative cause for the anaemia.
absent history of exposure to chemicals and radiation
Although a positive history may be present in people with anaemia of chronic disease, it may prompt consideration of an alternative cause for the anaemia.
absent history of drugs known to be associated with risk of anaemia
Although a positive history may be present in people with anaemia of chronic disease, development of anaemia shortly after commencing a new drug may warrant investigation (as the drug may be the causative agent).
absent history of poor nutrition
Although a positive history may be present in people with anaemia of chronic disease, it may prompt consideration of poor nutrition as an alternative cause for the anaemia.
decreased exercise tolerance
It is often useful to determine what changes may have occurred in the patient's level of activity, as patients often reduce exertion to avoid symptoms.
shortness of breath with exercise
A common symptom of moderate or severe anaemia of any cause.
fatigue
This is a common symptom of moderate or severe anaemia of any cause.
Risk factors
strong
autoimmune disorders
malignancy
acute or chronic infection
The normal host response to infection entails cytokine release and immune system activation that leads to anaemia of chronic disease.[5]
critical illness, major trauma, or major surgery with delayed recovery
Anaemia of chronic disease (ACD) is very common among intensive care unit patients.[15]
Likewise, ACD results from tissue trauma and inflammation occurring with major trauma and major surgery.
chronic disease
Anaemia of chronic disease is common among patients with chronic kidney disease, congestive heart failure, and chronic pulmonary disease.[6][7]
This may be due to decreased erythropoietin production, reduced iron availability for erythropoiesis, and erythropoietin resistance associated with the systemic inflammatory process.
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