Anemia

of
Chronic Disease
Per WHO 42% of children
and 40% of females in the
world have anemia.
Anemia :
Anemia can cause organ
damage, heart failure.
50% of hospitalized
patients have anemia of In males Hemoglobin level
chronic disease which
frequently result in poor less than 13g per dL
recovery
(World Health
Organisation, 2020). In females: Hemoglobin
level less than 12g per dL
 Anemia of chronic disease

Occur secondary to any infection, malignancy,

inflammation, or chronic disease

Examples: RA, OA, Chron disease, Alcoholism, TB, Chronic

kidney disease liver disease, autoimmune disease
Pathogenesis:

Because of chronic inflammation the ability of

the body to absorb and utilize iron for RBC
production is decreased.

Hepcidin is a hormone made in the liver that

regulate iron availability in the body.

Hepcidin inhibits iron absorption in duodenum

and inhibit iron release from macrophages (
WBCs) in anemia of chronic inflammation
 Lab test for
diagnostic of anemia:
Complete blood
count.
Reticulocyte count.
Serum ferritin level.
 Laboratory Testing to Differentiate Between ACD and IDA

Incidents of anemia: Parameter ACD IDA

Serum iron Low to normal Low

Iron deficiency : acute
or chronic bleeding or TIBC Low High
malabsorption Tsat Low Very low (<10%)

Serum ferritin High Low

Anemia of chronic
disease: chronic Serum transferrin receptor Normal to slightly high High
condition or MCV Normal Low
inflammation MCHC Normal Low

RDW Normal to slightly high High

Bone marrow iron High Low

MCHC- mean corpuscular hemoglobin concentration; RDW- red blood cell

distribution width; Tsat-transferrin saturation, TIBC-total iron binding capacity,
MCV- mean corpuscular volume,
 • Goal of treatment :
improve oxygenation & blood oxygen
carrying capacity.
Treat with:
• Iron, folic acid and B12 supplement,
Treatment • Diet rich in the above hematopoietic
factors is recommended.
• Some patients need blood transfusion.

• (Wiciński et al., 2020)

 Treatment of anemia of chronic disease
• Treat underlying • Diet: consume diet • Supportive
Conditions: high in iron, folic treatment:
acid, B12 • Prevention of fall
Chemo/radiation
• Iron supplement or injury
Treatment of
autoimmune disorders • B12 PO or IM • Pain management
Treatment kidney • Folic acid • Monitor
disease supplement medications effect
• Supplement vit C and side effect

Blood transfusion.
 Differential Diagnosis

•Renal failure
•Myxedema coma
•Adrenal crisis
•Tuberculosis
•HIV
Complications
•Untreated anemia can be life-threatening and can even
cause death.
•Anemia results in a decreased oxygen-carrying capacity of
the blood. In the short term, the body can compensate
with an increase in heart rate and respiratory rate. If left
untreated, anemia can cause multi-organ failure. This can
include high output heart failure, angina, arrhythmias,
cognitive impairment, and renal failure, among others. In
pregnant women, untreated anemia can cause premature
birth and low birth weight.
 Patient Education

• Anemia is a condition with a decreased oxygen-carrying capacity of the blood. Anemia is

very common and caused by different conditions ranging from simple nutritional
deficiencies (iron, vitamin B12, and folic acid), blood loss, or other complicated causes.

• Anemia is a common medical condition and easily diagnosed with complete blood count.
Treatment can range from nutritional supplements (iron, vitamin B12, and folic acid) to
blood transfusion to treating complex underlying conditions. Encouraging patients to eat a
healthy and balanced diet is important to prevent anemia due to nutritional deficiencies.
• Women of childbearing age are at increased risk of anemia due to pregnancies and
menstrual bleeding and need close monitoring.

• It is very important to follow up with the provider and sometimes with a specialist to treat
anemia because untreated anemia can be life-threatening and may even cause death.
 Nephrology in
Gastroenterolog
patients with
y if GI bleeding
chronic kidney
suspected
disease

Consultations
Hematology if
Obstetrics and
bone marrow
gynecology
disease or
(OB/GYN) for
hemolysis is
menorrhagia
suspected
 Badireddy,M& Baradhi, K. (2022)Chronic Anemia
StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK534803/
Madu, A. J., & Ughasoro, M. D. (2017). Anaemia of Chronic
Disease: An In-Depth Review. Medical principles and practice :
international journal of the Kuwait University, Health Science
Centre, 26(1), 1–9. https://doi.org/10.1159/000452104

References: Wiciński, M., Liczner, G., Cadelski, K., Kołnierzak, T., Nowaczewska,
M., & Malinowski, B. (2020). Anemia of Chronic Diseases: Wider
Diagnostics-Better Treatment?. Nutrients, 12(6), 1784.
https://doi.org/10.3390/nu12061784

World Health Organisation. (2020). Anaemia. Www.who.int; World

Health Organisation.
https://www.who.int/health-topics/anaemia#tab=tab_1