Anemia of chronic disease

Anemia of chronic disease is multifactorial and likely due to impaired iron mobilization and decreased intestinal absorption of iron.

↓RBC production due to impaired iron utilization and functional iron deficiency from ↑ hepcidin; cytokines (IL-6,TNF-α) cause ↓ epo responsiveness/production

Etiologies: autoimmune disorders, chronic infection, inflammation, HIV, malignancy

Dx: ↑ Fe, ↓ TIBC (usually normal or low transferrin sat), ± ↑ ferritin; usually normochromic, normocytic ( 70% of cases) but can be microcytic if prolonged.

Coexisting iron deficiency common. Dx clues include ↓ serum ferritin levels, absence of iron staining on BM bx, + response to a trial of oral iron, and/or ↑ soluble transferrin receptor/ferritin index.

Treatment: treat underlying disease ± erythropoietin (? if Epo < 500 mU/mL); for cancer- or chemo-related ACI, use epo if Hb ≤10 g/dL. Iron if ferritin < 100 or Fe/TIBC < 20%.