From the Guidelines
Treating anemia of chronic disease requires a multifaceted approach that prioritizes addressing the underlying condition causing inflammation, while also supporting blood health with erythropoiesis-stimulating agents and iron supplementation as needed. The primary approach involves treating the underlying disease such as infection, autoimmune disorder, or cancer with appropriate therapies.
- Iron supplementation is generally not effective alone since this type of anemia stems from iron sequestration rather than deficiency.
- Erythropoiesis-stimulating agents (ESAs) like epoetin alfa (Epogen, Procrit) at 50-300 units/kg three times weekly or darbepoetin alfa (Aranesp) at 0.45-4.5 mcg/kg weekly may be prescribed when hemoglobin falls below 10 g/dL, as supported by recent guidelines 1.
- In some cases, intravenous iron such as iron sucrose (Venofer) 200-300 mg or ferric carboxymaltose (Injectafer) 750-1000 mg may be added to enhance ESA response.
- Blood transfusions are reserved for severe anemia (hemoglobin <7-8 g/dL) or symptomatic patients. This approach works because chronic inflammation increases hepcidin production, which blocks iron release from storage sites and reduces iron availability for red blood cell production, as explained in the context of chronic kidney disease 1 and inflammatory bowel diseases 1. By treating the underlying condition and supporting erythropoiesis, the body can restore normal iron metabolism and red blood cell production, ultimately improving quality of life and reducing morbidity and mortality, in line with clinical practice guidelines for the evidence-based use of erythropoietic-stimulating agents 1.
From the Research
Management of Anemia of Chronic Disease (ACD)
To manage ACD, the following steps can be taken:
- Undertake in-depth diagnostics, including assessment of complete blood count and biochemical parameters, as well as severity of the underlying disease 2
- Differential diagnosis of ACD is primarily based on the exclusion of other types of anemia, in particular iron deficiency 2
- The basic form of treatment of ACD remains supplementation with iron, folic acid, and vitamin B12, as well as a diet rich in these hematopoietic factors 2
- The route of administration (oral, intramuscular, or intravenous) requires careful consideration of the benefits and possible side effects, and assessment of the patient's clinical status 2
Treatment Options
Treatment options for ACD include:
- Iron therapy, which can be given intravenously, as this can be safely administered to patients with chronic diseases 3
- Erythropoiesis stimulating agents (ESAs), which can help restore effective red cell production 3
- Recombinant erythropoietin therapy, which can correct ACD, but not iron deficiency anemia 4
- Treatment with erythropoietic agents, supplemented with iron if necessary, can be helpful in many cases 5