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Anemia of Chronic Disease (Anemia of Inflammation)

Anemia of Chronic Disease (Anemia of Inflammation) is a topic covered in the 5-Minute Pediatric Consult.

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  • Anemia that accompanies a variety of systemic diseases, with the common features of chronicity and inflammation
  • Anemia of chronic disease is more properly called anemia of inflammation (AI) and is the combined result of mildly increased destruction of RBCs, relative erythropoietin resistance, and iron-restricted erythropoiesis.


Typically mild to moderate anemia (Hgb 7 to 12 g/dL); develops in the setting of infection, inflammatory disorders, and some malignancies

  • Deficient cellular iron in the setting of hepcidin excess (functionally inaccessible iron)
  • Typically normochromic, normocytic but, if long-standing, can be hypochromic, microcytic (especially in children)
  • Main mechanism appears to be
    • Hepcidin is increased by interleukin-6 (IL-6), causing depletion of ferroportin, the only known membrane iron transporter.
    • Elevated hepcidin results in macrophage inability to release iron recycled from senescent RBCs, hepatocyte inability to release stored iron, and enterocyte inability to absorb dietary iron.
    • These changes lead to iron restriction with decreased iron available for erythropoiesis.
  • Other factors contributing to anemia in various degrees include the following:
    • Increased red cell destruction
    • Diagnostic phlebotomy or other blood loss
    • Inflammatory cytokines suppress erythropoiesis
    • Cytokine-mediated suppression of erythropoiesis
    • Cytokines such as interleukin-1 (IL-1) and IL-6 can activate ferritin synthesis, leading to sequestration of iron, which eventually is converted into hemosiderin.


Underlying disease process

Commonly Associated Conditions

  • Underlying disease process
    • Infections, both acute and chronic
    • Inflammatory disease
    • Collagen vascular diseases
    • Malignancies
    • Renal failure
  • Anemia of chronic disease often coexists with other causes of anemia, including:
    • Occult blood loss
    • Hemolysis
    • Dietary iron deficiency
    • Drug-related marrow suppression

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Cabana, Michael D., editor. "Anemia of Chronic Disease (Anemia of Inflammation)." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617791/all/Anemia_of_Chronic_Disease__Anemia_of_Inflammation_.
Anemia of Chronic Disease (Anemia of Inflammation). In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617791/all/Anemia_of_Chronic_Disease__Anemia_of_Inflammation_. Accessed April 22, 2019.
Anemia of Chronic Disease (Anemia of Inflammation). (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617791/all/Anemia_of_Chronic_Disease__Anemia_of_Inflammation_
Anemia of Chronic Disease (Anemia of Inflammation) [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 22]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617791/all/Anemia_of_Chronic_Disease__Anemia_of_Inflammation_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Anemia of Chronic Disease (Anemia of Inflammation) ID - 617791 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617791/all/Anemia_of_Chronic_Disease__Anemia_of_Inflammation_ PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -