Anemia of Chronic Disease | Causes and Treatments

ACD is a mild to moderate normocytic normochromic anemia, with less than 25% of cases showing microcytic hypochromic anemia, in which the mean corpuscular volume is rarely less than 70.

In contrast, iron deficiency anemia is microcytic, hypochromic, and has anisocytosis and poikilocytosis on a peripheral blood smear.

ACD patients have low serum iron, total iron-binding capacity, and transferrin saturation, which is accompanied by an increase in serum ferritin and bone marrow iron stores.

Serum iron, transferrin saturation, and ferritin are all low in iron deficiency anemia, while total iron-binding capacity is increased.

It can be difficult to distinguish between ACD and iron deficiency anemia based on available laboratory tests, and it’s even more difficult when the two conditions coexist.

Anemia of chronic disease, also known as anemia of chronic inflammation, is caused primarily by infections, autoimmune disorders, chronic renal insufficiency, and malignancies (both hematologic and solid tumors).

The pathophysiology of ACD is complex, but it can be summarized as three major causes, which are rooted in increase in pro-inflammatory cytokines, increase in hepcidin plays a key role and inappropriate erythropoietin levels or hypo-responsiveness to erythropoietin, as well as erythropoiesis suppression in the bone marrow and reduced red blood cell survival.

Measuring soluble transferrin receptors and hepcidin levels can be used to distinguish between anemia of chronic disease and iron deficiency anemia.

Treatment for ACD aims to improve the blood’s oxygen-carrying capacity.

The improvement of anemia contributes to the improvement of these patients’ quality of life. The currently available treatments either as conventional therapy or novel agents.