From the Guidelines
Anemia of chronic disease typically presents with symptoms of fatigue, weakness, pale skin, shortness of breath, dizziness, and decreased exercise tolerance, as seen in patients with inflammatory bowel disease [IBD] 1. These symptoms develop gradually as the body's red blood cell count and hemoglobin levels decline. Patients may also experience cold hands and feet, headaches, and in severe cases, chest pain or irregular heartbeat.
- The severity of symptoms correlates with the degree of anemia and the underlying condition causing it, such as IBD, which can substantially affect the quality of life of patients 1.
- Unlike iron deficiency anemia, patients with anemia of chronic disease often don't show specific cravings for ice or other non-food substances (pica).
- This type of anemia occurs secondary to chronic inflammatory conditions, infections, or malignancies where the body's inflammatory response interferes with iron utilization and red blood cell production, as noted in the European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases 1.
- The body essentially sequesters iron in storage sites, making it unavailable for hemoglobin synthesis, while also reducing the lifespan of red blood cells and impairing the bone marrow's response to erythropoietin.
- Treatment focuses primarily on addressing the underlying chronic condition rather than iron supplementation, as iron levels in storage are typically normal or elevated despite the anemia, highlighting the importance of preventive measures and maintenance of iron and vitamin stores in patients with IBD 1.
From the Research
Symptoms of Anemia of Chronic Disease
- Anemia of chronic disease is a common condition that occurs in patients with chronic illnesses, such as cancer, rheumatoid arthritis, and heart failure 2, 3, 4.
- The symptoms of anemia of chronic disease can include a decrease in quality of life, increased morbidity and mortality, and a reduction in hemoglobin concentration 3, 4.
- The condition is often characterized by normocytic and normochromic anemia, which can make diagnosis difficult 4.
- Anemia of chronic disease can also coexist with iron deficiency anemia, making diagnosis and treatment more challenging 5.
Pathophysiology of Anemia of Chronic Disease
- The pathogenesis of anemia of chronic disease involves the activation of the immune system, leading to the release of cytokines and an increase in serum hepcidin 2, 4.
- This can result in hypoferraemia, suppression of erythropoiesis, and a decrease in erythropoietin (EPO) production 4.
- The condition can also lead to a shortening of the half-life of red blood cells, further contributing to anemia 4.
Diagnosis and Treatment of Anemia of Chronic Disease
- Diagnosis of anemia of chronic disease requires a thorough understanding of the underlying disease and its clinical pathways 2.
- Treatment options include the use of erythropoiesis-stimulating agents, blood transfusion, and iron supplementation, in addition to treating the underlying disease 2, 3, 4.
- Intravenous iron therapy may be beneficial for patients with anemia of chronic disease, particularly those with concomitant iron deficiency 3, 6.