Anemia of Chronic Disease (Anemia of Inflammation)
Basics
Description
- 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.
Pathophysiology
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.
Etiology
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
There's more to see -- the rest of this topic is available only to subscribers.
Citation
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 MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617791/all/Anemia_of_Chronic_Disease__Anemia_of_Inflammation_. Accessed October 13, 2024.
Anemia of Chronic Disease (Anemia of Inflammation). (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. 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 MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2024 October 13]. 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 -