Anaemia of chronic disease

Anaemia of chronic disease (ACD) is characterised by anaemia and evidence of immune system activation.

Anaemia is mainly due to decreased red blood cell production; may be aggravated by shortened red blood cell survival.

Commonly found in acute and chronic infections; autoimmune disorders; chronic diseases; malignancy; after major trauma, surgery, or critical illness; and among older adults.

Physical examination findings are those of the underlying disorder.

Therapeutic approach is primarily treatment of the underlying disorder, although treatment of the anaemia itself is sometimes appropriate.

ACD is a common syndrome in which the anaemia is due to an inflammation-mediated reduction in red blood cell (RBC) production and sometimes in RBC survival.[1]Roy CN. Anemia of inflammation. Hematology Am Soc Hematol Educ Program. 2010;2010:276-80. http://asheducationbook.hematologylibrary.org/cgi/content/full/2010/1/276 http://www.ncbi.nlm.nih.gov/pubmed/21239806?tool=bestpractice.com [2]Papadaki HA, Kritikos HD, Valatas V, et al. Anemia of chronic disease in rheumatoid arthritis is associated with increased apoptosis of bone marrow erythroid cells: improvement following anti-tumor necrosis factor-alpha antibody therapy. Blood. 2002 Jul 15;100(2):474-82. https://www.doi.org/10.1182/blood-2002-01-0136 http://www.ncbi.nlm.nih.gov/pubmed/12091338?tool=bestpractice.com

Laboratory studies, which collectively identify the syndrome, typically show normocytic normochromic or microcytic hypochromic anaemia, relatively low absolute reticulocyte count, low serum iron, low total iron-binding capacity, low to normal percent transferrin saturation, and elevated ferritin.