A person with anemia of chronic disease has decreased red blood cells despite having “normal” or increased iron stores in their body. It can occur in people with underlying inflammatory conditions, such as cancer and chronic kidney disease.
Anemia is a condition where the body does not have enough red blood cells. Since red blood cells transport oxygen, the tissues and organs do not receive enough oxygen. This results in symptoms such as lightheadedness and tiredness.
Treatment for this type of anemia involves addressing the underlying conditions causing it. In rare cases, blood transfusions may be necessary.
This article discusses the causes, symptoms, and diagnosis of anemia of chronic disease, as well as the treatments available.
Another name for anemia of chronic disease is “anemia of inflammation.” The term reflects the fact that it affects people who have conditions that cause inflammation.
A person with any type of anemia has fewer than normal red blood cells. Additionally, their red blood cells may contain low levels of hemoglobin. Hemoglobin is the iron-rich protein that transports oxygen from the lungs to all tissues in the body.
Fewer red blood cells or low hemoglobin levels may prevent the body from getting enough oxygen, which is essential for bodily functions.
In anemia of chronic disease, a person’s body has normal or higher stores of iron but low levels of iron in the blood. Inflammation
- autoimmune conditions, such as rheumatoid arthritis or lupus
- inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn’s disease
- chronic kidney disease
- chronic infections, such as HIV and tuberculosis
- heart failure
Some people may have more than one underlying condition. For example:
- IBD may involve iron deficiency anemia and anemia due to inflammation.
- Chronic kidney disease may involve inflammation-induced anemia from the effects of the condition, along with iron deficiency anemia stemming from hemodialysis.
- Cancer may involve anemia from blood loss and inflammation, but chemotherapy and radiation may also cause or worsen anemia.
Aside from all the above conditions, aging may cause inflammation and anemia.
Additionally, anemia of critical illness is a type of anemia of chronic disease. It may rapidly develop in people who are hospitalized for trauma, an infection, or another condition that causes inflammation.
Theoretically, any underlying condition that can cause inflammation is a risk factor for anemia of chronic disease.
Scientists believe that when a person has an inflammation-causing condition, their immune system produces changes that can lead to anemia. These changes may include the
- The kidneys may synthesize less erythropoietin, a hormone that stimulates the bone marrow to make red blood cells.
- The bone marrow may not respond as it should to erythropoietin.
- The body may not store and use iron normally.
- The red blood cells may have a shorter than normal life span, which would result in them dying more rapidly than the body can replace them.
Anemia of chronic disease varies in severity, but in most cases, it is mild to moderate. Some signs and symptoms include:
Usually, the symptoms of the underlying condition are more important than the mild or moderate symptoms of this anemia.
In rare cases, symptoms are severe, which may lead to serious complications.
Doctors base a diagnosis on a person’s:
- physical symptoms
- medical history
- lab test results
The lab tests may measure:
- red blood cell count
- hemoglobin level
- iron level in blood serum
- total iron binding capacity
- transferrin, a protein that plays a role in the transfer of iron from the intestines to the blood
- ferritin, a protein that binds to iron
Doctors aim for treatment to address the underlying cause of the anemia. If treatment alleviates the underlying cause, the anemia typically gets better or completely goes away without direct intervention.
Treatment with iron supplements is generally not effective. Such supplements can adversely affect health. For example, some microbes that cause infections use iron as nourishment.
In rare cases of severe anemia, doctors may prescribe a blood transfusion. This can quickly increase hemoglobin and raise oxygen levels. Another treatment for rare cases is drugs that stimulate the synthesis of erythropoietin.
A 2019 study noted that researchers are gathering information on the effectiveness of different treatment approaches. At this point, they do not have enough data to project the outlook for people with this condition.
Both types of anemia share some similarities, but lab results can help distinguish the type a person has.
In iron deficiency anemia, the body uses the stored iron to make red blood cells. However, due to low iron stores, the body depletes the iron, which results in fewer red blood cells. Consequently, iron levels are low in body tissues and in the blood.
Below are some common questions and answers about anemia of chronic disease.
What ICD-10 codes are associated with anemia of chronic disease?
This system has an extensive list of codes that designate specific diseases, including various types of anemia. For example, it has a code for anemia due to cancer and another for anemia due to chronic kidney disease.
The code for “anemia due to other chronic diseases classified elsewhere” is D638.
Why are ferritin levels high in anemia of chronic disease?
Ferritin levels are either normal or high in anemia of chronic disease because it is an indicator of the amount of iron stores.
Since the body has higher iron stores in this type of anemia, high ferritin levels would suggest this diagnosis.
How does anemia of chronic disease affect TIBC?
TIBC, or total iron-binding capacity, is an indirect way to measure transferrin, a protein that transports iron. In anemia of chronic disease, TIBC is
In other types of anemia, TIBC may be higher, likely due to people having lower iron stores. This may be the case for iron deficiency anemia.
Anemia of chronic disease stems from inflammation associated with certain conditions, such as cancer and chronic kidney disease. The inflammation prevents the body from using iron stores to make red blood cells.
Because the body’s iron stores are normal or high in the condition, a key diagnostic indicator is a blood test for ferritin, a protein that binds to iron.
Doctors do not treat this anemia with iron supplements. Instead, they treat the underlying condition. In rare cases, blood transfusions or medications that increase the body’s synthesis of erythropoietin may be necessary.
The outlook for people with this condition is not yet known, but research continues to investigate it.