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Anemia of Chronic Disease

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Read this article to learn about the symptoms, causes, diagnosis, and management of the anemia of chronic disease, also known as anemia of inflammation.

Medically reviewed by

Dr. Abdul Aziz Khan

Published At April 3, 2023
Reviewed AtApril 3, 2023


Anemia of chronic disease occurs when the patient suffers from an autoimmune disorder or another chronic inflammatory disease that lasts more than three months. Chronic inflammation usually affects the body’s ability to use the iron reserves needed to produce enough red blood cells. Anemia occurs when the body fails to produce sufficient red blood cells.

What Is Anemia of Chronic Disease?

Anemia of chronic disease is anemia affecting people who suffer from inflammatory conditions such as chronic infections, autoimmune disorders, malignant tumors, and chronic renal diseases.

Anemia occurs when the blood has fewer than normal red blood cells. The red blood cells may also contain less hemoglobin. Hemoglobin is an iron-containing protein. It allows red blood cells to transport oxygen from the respiratory organs to other body parts. Oxygen is needed by the body to meet energy requirements. The body will not get sufficient oxygen with fewer RBCs (red blood cells) or reduced hemoglobin.

In anemia of chronic disease, the amount of iron stored in the body tissues is increased. However, iron levels are low in the blood. Chronic diseases might prevent the body from utilizing stored iron reserves to produce a sufficient number of healthy red blood cells, thereby causing anemia of chronic disease.

Who Is More Likely to Be Affected by Anemia of Chronic Disease?

Anemia of chronic disease can affect any person suffering from a chronic disorder. Most people affected by this condition are aged 65 years and older. Medical literature has shown that approximately one million people in the United States of America aged 65 years and above suffer from chronic disease anemia. Diseases that may lead to anemia of chronic disease include:

  • Malignant tumors (cancers).

  • Chronic renal disorders (kidney diseases).

  • Congestive heart failure (a condition where the blood is not pumped properly by the heart muscles).

  • Autoimmune disorders (diseases where the body begins to attack healthy cells).

  • Infective diseases.

  • Obesity (an excessive amount of fat in the body).

  • People undergoing radiotherapy or chemotherapy.

How Common Is Anemia of Chronic Disease?

Anemia of chronic disease or anemia of inflammation is the second most commonly occurring type after iron-deficiency anemia.

What Are the Causes of Anemia of Chronic Disease?

In case of a chronic infection,

  • The body normally loses its ability to store and utilize iron reserves.

  • The kidneys also produce significantly less erythropoietin (a hormone that stimulates the bone marrow to produce red blood cells).

  • The bone marrow will not normally respond to erythropoietin producing fewer red blood cells than required.

  • The red blood cells will have a shorter life span than normal which in turn causes them to die faster than they can be restored.

Chronic Conditions Leading to Anemia of Chronic Disease:

  • Autoimmune disorders include rheumatoid arthritis, lupus erythematosus, vasculitis, etc.

  • Neoplastic tumors.

  • Human Immunodeficiency Virus (Acquired Immunodeficiency Syndrome).

  • Tuberculosis (TB).

  • Chronic kidney diseases.

  • Crohn’s disease (inflammatory bowel syndrome).

  • Diabetes.

  • Heart failure.

  • Severe acute infections.

  • Aging.

What Are the Symptoms of Anemia of Chronic Disease?

Anemia of chronic disease usually develops gradually and may cause a few clinical symptoms. Some of these clinical features include

  • Tachycardia (rapid heart rate).

  • Malaise.

  • Body ache.

  • Lightheadedness.

  • Fatigue.

  • Skin pallor.

  • Dyspnea (breathlessness).

How to Diagnose Anemia of Chronic Disease?

The healthcare professional may advise the following diagnostic tests:

  • Hemoglobin Levels: Normal hemoglobin levels range from 12 to 18 grams per deciliter of blood.

  • Erythropoietin Levels: If the hemoglobin level is less, it is advisable to check the erythropoietin level. Erythropoietin is a hormonal protein in the kidneys that stimulates the bone marrow to produce red blood cells.

  • Serum Iron Level: The liquid part of blood is called serum. This test is used to measure the iron levels in the blood serum. The normal value of serum iron ranges from 60 to 170 micrograms per deciliter of blood.

  • Reticulocyte Count: Immature red blood cells are known as reticulocytes. A low reticulocyte count suggests that the bone marrow is not synthesizing enough red blood cells.

  • Total Iron-Binding Capacity: This test measures the ability of the blood to bind itself to iron. The normal value for adults ranges from 240 to 450 micrograms per deciliter of blood.

  • Serum Ferritin Level: Ferritin is an intracellular blood protein that comprises iron. This test measures the amount of iron stored by the body. If the serum ferritin levels are lower than normal, it is suggestive of low iron reserves in the body, causing iron deficiency.

  • Bone Marrow Biopsy: This test measures iron reserves and serum iron levels. Very high iron reserves and low serum iron value may indicate anemia of chronic disease.

What Is the Treatment of Anemia of Chronic Disease?

Treatment typically depends on the underlying pathology that causes anemia. If the underlying disease is eliminated, the symptoms of anemia will also subside. People with anemia that is caused by malignancy or chronic renal disease may require additional treatment modalities, such as:

  • Blood Transfusion: Blood transfusions may be used as short-term treatment therapy by doctors to treat severe anemia in patients. However, they are not a long-term remedy because of a few side effects involving hemochromatosis (iron overload) and the risk of infection.

  • Synthetic Erythropoietin Therapy: It is a man-made injection that is given to boost erythropoietin levels. This injection will stimulate the bone marrow to synthesize more RBCs (red blood cells).

  • Iron Supplements: Doctors usually combine supplemental iron therapy and synthetic erythropoietin injection.

How to Reduce the Risk of Developing Anemia of Chronic Disease?

The following precautions can be taken to prevent the disease from developing:

  • Consumption of lean protein such as chicken, turkey, and pulses.

  • Dark green leafy vegetables such as spinach and kale.

  • Iron-fortified bread.

  • Iron-rich foods.

  • Multivitamin supplements include vitamin B12 (cobalamin), folic acid, and iron.


Anemia of chronic disease is a long-term sickness having its own challenges. The affected person may get tired very easily and feel exhausted. It is very important to consult a healthcare professional as soon as possible. Lifestyle changes, including a few dietary changes and exercise, may reduce the risk of developing anemia. Usually, the disease is resolved successfully by eliminating the underlying pathology.

Frequently Asked Questions


Why Is Ferritin Concentration Elevated in Chronic Anemia?

The levels of serum ferritin that are considered normal typically range from 15 to 300 g/L. Therefore, people who have ACD typically have elevated serum ferritin levels due to the reticuloendothelial cells' tendency to retain iron and the increased production of ferritin that occurs as a result of inflammation.


Why Does Erythropoiesis Not Occur in Cases of Anemia Caused by Chronic Disease?

Erythropoiesis can be inhibited as a result of the combined activities of a number of inflammatory and anti-inflammatory cytokines and hormones. Ferroportin is the primary mechanism through which the majority of individuals regulate the release of iron from the intestinal mucosa and bone marrow macrophages.


In Chronic Anemia, What Does TIBC Stand For?

The TIBC test quantifies the capacity of blood to bind with iron and facilitate its transportation throughout the organism. The transferrin test exhibits similarities. Individuals with iron deficiency anemia, characterized by insufficient iron levels in the bloodstream, typically exhibit low iron levels alongside elevated total iron-binding capacity (TIBC).


What Causes a Reduction in TIBC?

A decreased total iron-binding capacity (TIBC) may indicate the presence of hemolytic anemia, a condition characterized by the accelerated destruction of red blood cells. Hypoproteinemia refers to a condition characterized by a below-average concentration of protein in the bloodstream in inflammation.


What Occurs to Transferrin During Chronic Anemia?

In ACD, the decreased transferrin saturation is not only caused by a lack of iron but also by an increased production of transferrin. Both of these factors contribute to the condition. The condition known as hypoferremia is brought on by the sequestration of iron within the cells of the reticuloendothelial system, and as a direct consequence of this, the transferrin saturation level is reduced.


Why Does Iron Deficit Reduce Electron Transport?

Iron deficiency poses a distinct energy-related obstacle as numerous oxidative enzymes within the electron transport chain, which are typically upregulated by AMPK activation, rely on iron for their functioning. Nevertheless, our investigation revealed a significant decrease in all examined iron-dependent mitochondrial proteins as a consequence of iron deficiency.


How Can Persistent Inflammation Cause Anemia, and What Is the Mechanism Behind It?

The etiology of anemia encompasses various mechanisms, such as compromised erythropoietin (Epo) production, impaired erythroid marrow response to Epo, iron-restricted erythropoiesis (which in turn hampers erythroid proliferation), and a reduced population of Epo-responsive cells.


What Is Differential Anemia of Chronic Disease?

Anemia of chronic disease is a prevalent form of anemia seen in hospitalized patients. This type of anemia is caused by diseases that have been present for a long time, such as infections, inflammations, and cancers. These persistent circumstances result in an increase in the amount of hepcidin that is produced by the liver.


What Is the Hemoglobin Level in Chronic Disease-Related Anemia?

It is uncommon for the hemoglobin concentration to go below 6 g/dL and often ranges from 8 to 9.5 g/dL (which indicates mild to moderate anemia). In cases when ACD is suspected, and severe anemia is present, it is imperative that all potential causes of red cell loss or destruction be thoroughly examined.


Why Is Intravenous Iron Not Administered for Chronic Anemia?

Intravenous iron may present a potentially more efficacious therapeutic option for anemia of chronic diseases linked to inflammation, such as cancer. This is due to its ability to circumvent resistance to iron absorption, particularly by erythroid cells, as well as iron recycling processes that are regulated by hepcidin.


How to Check for Iron Deficiency Anemia on Top of Chronic Illness Anemia?

- Hemoglobin Level: Hemoglobin provides red colors to blood cells. Normal hemoglobin is 12 to 17.4 g/dL. EPO level if the hemoglobin is low. Kidneys produce EPO to help bone marrow manufacture red blood cells.
- Serum Iron: The serum is blood liquid, and the test measures blood iron. 60 to 170 μg/dL is typical.
- Reticulocyte Count: Reticulocytes are immature red blood cells. Low reticulocyte counts may indicate low bone marrow red blood cell production.
- Iron-Binding Ability: This test measures iron levels where adults have 250 to 450 micrograms per deciliter of blood.
- Serum Ferritin Level: Iron-containing blood protein ferritin, the test determines iron reserves. Ferritin levels should be 20 to 200/500 ng/mL.
Dr. Abdul Aziz Khan
Dr. Abdul Aziz Khan

Medical oncology


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