From the Guidelines
Anemia of chronic disease can be caused by various chronic conditions, including infections, autoimmune disorders, chronic kidney disease, certain cancers, and chronic liver disease, as these conditions interfere with normal iron metabolism and red blood cell production. These chronic diseases trigger the release of cytokines that reduce iron availability for hemoglobin synthesis, decrease red blood cell lifespan, and impair the bone marrow's response to erythropoietin, the hormone that stimulates red blood cell production 1. Some of the key chronic conditions that can cause anemia of chronic disease include:
- Infections such as tuberculosis, HIV, endocarditis, and osteomyelitis
- Autoimmune disorders like rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease
- Chronic kidney disease
- Certain cancers, particularly lymphomas and solid tumors
- Chronic liver disease The inflammatory process in these conditions leads to the production of hepcidin, a hormone that blocks iron absorption from the gut and iron release from storage sites, further contributing to the anemia 1. Treatment of anemia of chronic disease typically focuses on addressing the underlying chronic condition rather than directly treating the anemia itself, though in some cases iron supplementation or erythropoiesis-stimulating agents may be considered depending on the severity of symptoms 1. It is essential to note that anemia can worsen cardiac function and is associated with poor outcomes, including increased risk for hospitalization and death, decreased exercise capacity, and poor quality of life 1. Therefore, managing the underlying chronic condition and monitoring for anemia is crucial to improve patient outcomes and quality of life.
From the FDA Drug Label
1.1 Anemia Due to Chronic Kidney Disease 1.2 Anemia Due to Zidovudine in Patients with HIV Infection 1.3 Anemia Due to Chemotherapy in Patients with Cancer
The chronic diseases that can cause anemia of chronic disease are:
- Chronic Kidney Disease
- HIV Infection (specifically, anemia due to zidovudine in patients with HIV infection)
- Cancer (specifically, anemia due to chemotherapy in patients with cancer) 2
From the Research
Chronic Diseases Causing Anemia
- Chronic kidney disease (CKD) can cause anemia, as evidenced by a study published in 2021 3, which discusses the pathophysiology and treatment of anemia associated with CKD.
- Rheumatoid arthritis (RA) is another chronic disease that can cause anemia, with a study from 2006 finding that anemia occurs in 31.5% of RA patients 4.
- Anaemia of chronic disease (ACD) is a common complication of various chronic diseases, including chronic infections, autoimmune disorders, and cancer, as discussed in a 2021 study 5.
- Anemia of chronic disease (ACD) or anemia of inflammation is a type of anemia that develops in the setting of acute or chronic immune activation, as described in a 2009 study 6.
- Rheumatoid arthritis (RA) is a specific example of a chronic disease that can cause anemia of chronic disease, as investigated in a 1992 study 7.
Key Characteristics of Anemia of Chronic Disease
- Anemia of chronic disease is characterized by low serum iron and often increased reticuloendothelial stores of iron 6.
- Hepcidin is the master regulator of iron homeostasis, and its synthesis is inhibited by iron deficiency and stimulated by inflammation 6.
- The serum hepcidin level is useful in identifying iron deficiency in patients with anemia of chronic disease 6.
- Successful treatment of the underlying disease improves anemia of chronic disease, and if that is not possible, treatment with erythropoietic agents, supplemented with iron if necessary, is helpful in many cases 6.