Anemia of chronic disease

Anemia of chronic disease

Updated: 07/29/2025

© Jun Wang, MD, PhD

 

General features

  • Anemia caused by chronic diseases, including chonic inflammation, infections and neoplasms
  • Chronic kidney disease (CKD) most common
  • Results of reduced RBC production

Pathogenesis

  • Cytokines, esp Il-6 and  IL-1, increased hepcidin production

o   Hepcidin inhibits iron metabolism in marrow

  • Erythropoietin production/activities suppressed

o   Renal diseases

o   Cytokine activites: Il-6, Il1, TNF

  • Erythropoiesis suppressed by cytokines: interferon-g
  • Reduced red cell lifespan

o   Activation of macrophages

o   Deposition of antibody and complement on RBC

Clinical features

  • Normochromic, normocytic anemia 1-2 months after onset of chronic illness

Laboratory findings

  • Usually normocytic, normochromic anemia
  • Inappropriately low reticulocyte count
  • May be hypochromic microcytic
  • Iron studies
    • Decreased
      • Iron
      • TIBC (due to reduced production of transferrin by liver) 
      • Transferrin saturation
    • Increased: ferritin 

Management

  • Underlying diseases
  • Erythropoietin
  • Supplementation of iron, folate, etc

 

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