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Anemia of chronic disease

Definition

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anemia.

Anemia of chronic disease (ACD) is anemia that is found in people with certain long-term (chronic) medical conditions that involve inflammation.

Causes

Anemia is a lower-than-normal number of red blood cells in the blood. ACD is a common cause of anemia. Some conditions that can lead to ACD include:

• Autoimmune disorders, such as Crohn disease, systemic lupus erythematosus, rheumatoid arthritis, and ulcerative colitis

• Cancer, including lymphoma and Hodgkin disease

• Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS, lung abscess, hepatitis B or hepatitis C

Symptoms

Anemia of chronic disease is often mild. You may not notice any symptoms.

When symptoms occur, they may include:

• Feeling weak or tired

• Headache

• Paleness

• Shortness of breath

Exams and Tests

Your health care provider will perform a physical exam.

Anemia may be the first symptom of a serious illness, so finding its cause is very important.

Tests that may be done to diagnose anemia or rule out other causes include:

• Complete blood count (CBC)

• Reticulocyte count

• Serum ferritin level

• Serum iron level

• C-reactive protein level

• Erythrocyte sedimentation rate

• Bone marrow aspiration (in rare cases to check for cancer)

Treatment

Anemia is often mild enough that it does not need treatment. It may get better when the disease that is causing it is treated.

More severe anemia, such as that caused by cancer or HIV/AIDS may require:

• Blood transfusion

• Erythropoietin, a hormone produced by the kidneys, given as a shot

Outlook (Prognosis)

The anemia will improve when the disease that is causing it is treated.

Possible Complications

Discomfort from symptoms is the main complication in most cases. Anemia may lead to a higher risk for death in people with heart failure.

When to Contact a Medical Professional

Contact your provider if you have a long-term (chronic) disorder and you develop symptoms of anemia.

References

Elghetany MT, Banki K. Erythrocytic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 33.

Ginzburg YZ. Anemia of chronic inflammation. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 38.

Means RT. Approach to the anemias. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 144.

Review Date: 3/31/2024

Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.