anaemia of chronic disease

anaemia of chronic disease

A form of anaemia that accounts for 1/4 of all anaemias in hospitalised patients; it is the predominant form of hypoproliferative anaemia, which interferes with RBC production and shortens RBC lifespan, and is seen in patients with arthritis, chronic infections, and malignancy.
 
Clinical findings
The findings in anaemia of chronic disease reflect the underlying aetiology.

Lab
Mild-to-moderate anaemia, often microcytic ± hypochromic; iron stores may be low/normal; RBC indices may be normal.
 
Pathogenesis
Unknown; possibly related to IFN-gamma produced by activated macrophages.
 
Management
Transfusion, erythropoietin.
References in periodicals archive ?
The predominant morphologic pattern of anaemia in CKD has been described as similar to the pattern seen in anaemia of chronic disease. [12] In CKD, microcytosis may be attributed to ID and/or haemoglobinopathies, while macrocytosis may be attributed to folate and/or vitamin B12 deficiency.
A more nuanced approach may be warranted in primary care, where iron deficiency anaemia (IDA) [2] and anaemia of chronic disease (ACD) are common.
It is an acute-phase reactant and its level increases in liver damage and inflammatory states while its level decreases in iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD).4
On the other hand, anaemia of chronic disease (ACD) is characterized by normal or increased ferritin levels, as a result of increased storage and retention of iron within the reticuloendothelial system; in fact, during chronic inflammatory diseases proinflammatory cytokines lead to the activation of macrophages which augment their erythrophagocytic activity and express increased levels of divalent metal transporter1 (DMT-1), a transmembrane protein functioning as a major iron uptaker.
Anaemia of chronic disease was present in 53% of the patients with renal insufficiency as the most frequent pathology seen in 11% patients.
The mean HbA1c level and proposed reference ranges for the five anaemia subgroups (anaemia of chronic disease [ACD], iron deficiency anaemia [IDA], mixed anaemia, macrocytic anaemia and sickle-cell disease) are shown in table 2.
Traditionally, anaemic patients have been divided into two groups: those with "iron deficiency anaemia" (IDA) and those with "anaemia of chronic disease" (ACD).
Recombinant human erythropoietin improves health-related quality of life in patients with rheumatoid arthritis and anaemia of chronic disease; utility measures correlate strongly with disease activity measures.
The aetiology of anaemia in HIV infection is multifactorial and typically the anaemia results from underproduction of red blood cells and frequently the laboratory features are compatible with anaemia of chronic disease with a low reticulocyte count, normocytic and normochromic red blood cells with normal iron stores and cytokine mediated poor erythropoietin response (9-11).
Anaemia of chronic disease plays a very important role in this population group, and is estimated to occur in 18 - 95% of cases.