Diagnosis of Anemia of Chronic Disease
Yes, this is most likely anemia of chronic disease (ACD) based on the laboratory findings and clinical context of chronic inflammation.
Diagnostic Criteria for Anemia of Chronic Disease
The diagnosis of anemia of chronic disease depends on specific laboratory parameters in the context of an underlying inflammatory condition:
In the presence of inflammation, the diagnostic criteria for ACD are:
If serum ferritin is between 30-100 μg/L with evidence of inflammation, a combination of true iron deficiency and ACD is likely 1
Laboratory Findings to Support ACD Diagnosis
When evaluating for ACD, several key laboratory tests should be ordered:
- Complete blood count with indices (MCV, RDW)
- Reticulocyte count (typically low in ACD)
- Iron studies (ferritin, transferrin saturation, TIBC)
- Inflammatory markers (CRP, ESR) 2
The key distinguishing features of ACD compared to iron deficiency anemia include:
| Parameter | Iron Deficiency Anemia | Anemia of Chronic Disease |
|---|---|---|
| MCV | Low (microcytic) | Normal (normocytic) |
| Serum iron | Low | Low |
| TIBC | High | Low/Normal |
| Ferritin | < 30 μg/L | > 100 μg/L |
| Transferrin saturation | < 15% | < 20% |
Underlying Conditions Associated with ACD
ACD is commonly associated with several chronic inflammatory conditions:
- Autoimmune diseases (including rheumatoid arthritis, SLE)
- Inflammatory bowel disease
- Chronic infections
- Malignancies
- Adult-onset Still's disease 1
In Adult-onset Still's disease specifically, anemia of chronic disease is a common hematological abnormality that occurs with active disease and often returns to normal when the disease subsides 1.
Management Approach
Treatment should primarily focus on the underlying inflammatory condition. For ACD management:
Address the underlying inflammatory condition first
- This is the most effective approach to resolving ACD
Consider iron supplementation only if concurrent iron deficiency is present
- Avoid unnecessary iron supplementation in pure ACD as it may not improve anemia and could potentially worsen inflammation 2
Consider erythropoiesis-stimulating agents (ESAs) for severe or symptomatic anemia
Important Caveats
- Misdiagnosing ACD as iron deficiency can lead to inappropriate treatment
- Always rule out concurrent iron deficiency, which may require different management
- Transfusions should be reserved for severe, symptomatic anemia or when rapid correction is needed
- Monitor response to therapy with regular hemoglobin checks (every 2-4 weeks initially)
In summary, the presence of anemia with evidence of chronic inflammation, normal to elevated ferritin levels, and low transferrin saturation strongly supports the diagnosis of anemia of chronic disease.