What is the diagnosis and treatment of anemia of chronic disease (Anemia of Chronic Disease, ACD)?

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Last updated: March 28, 2025 • View editorial policy

From the Guidelines

Anemia of chronic disease (ACD) should be diagnosed and treated according to the most recent European Crohn's and Colitis Organization (ECCO) guidelines, which recommend assessing all patients with inflammatory bowel disease (IBD) for anemia, and using serum ferritin and transferrin saturation to differentiate between iron deficiency anemia and ACD 1.

Diagnosis of Anemia of Chronic Disease

The diagnosis of ACD is based on laboratory findings, including:

  • Serum ferritin >100 mg/L
  • Transferrin saturation <20%
  • Normocytic or mildly microcytic anemia In patients with inflammation, a serum ferritin level up to 100 mg/L may still be consistent with iron deficiency, and a combination of true iron deficiency and ACD is likely if the serum ferritin level is between 30 and 100 mg/L 1.

Treatment of Anemia of Chronic Disease

Treatment of ACD primarily focuses on addressing the underlying condition causing the inflammation.

  • Iron supplementation is recommended in all patients with IBD and iron-deficiency anemia, and intravenous iron is more effective and better tolerated than oral iron 1.
  • Erythropoiesis-stimulating agents (ESAs) like erythropoietin may be prescribed to boost red blood cell production in patients with insufficient response to intravenous iron and optimized IBD therapy, with a target hemoglobin level not above 12 g/dL 2.
  • Blood transfusions may be necessary for severe anemia causing symptoms.

Key Considerations

  • Quality of life improves with correction of anemia, and this improvement is independent of clinical activity 1.
  • The estimation of iron need is usually based on baseline hemoglobin and body weight 1.
  • After successful treatment of iron deficiency anemia with intravenous iron, re-treatment with intravenous iron should be initiated as soon as serum ferritin drops below 100 mg/L or hemoglobin below 120 or 130 g/L according to gender 1.

From the FDA Drug Label

In controlled trials, patients experienced greater risks for death, serious adverse cardiovascular reactions, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL [see Warnings and Precautions (5.1)]. No trial has identified a hemoglobin target level, Aranesp dose, or dosing strategy that does not increase these risks [see Dosage and Administration (2.2)]. Use the lowest Aranesp dose sufficient to reduce the need for red blood cell (RBC) transfusions [see Warnings and Precautions (5. 1)].

The diagnosis of anemia of chronic disease (ACD) is not directly addressed in the provided drug labels. The treatment of ACD is also not explicitly mentioned, but it can be inferred that erythropoiesis-stimulating agents (ESAs), such as epoetin alfa and darbepoetin alfa, may be used to reduce the need for red blood cell (RBC) transfusions in patients with anemia due to chronic kidney disease (CKD) or cancer.

  • The dosage of ESAs should be individualized and the lowest dose sufficient to reduce the need for RBC transfusions should be used.
  • Hemoglobin levels should be monitored regularly to avoid targeting a level greater than 11 g/dL, which may increase the risk of death, serious adverse cardiovascular reactions, and stroke [3] [4].

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.