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(Anemia of Inflammation; Hypoferremia of Inflammatory Disease; ACD)

Definition

Certain long term medical conditions, such as cancer and infectious and inflammatory diseases can cause anemia. Anemia is a low level of healthy red blood cells (RBC). RBCs carry oxygen from the lungs to the rest of the body. When red blood cells are low the body does not get enough oxygen. This can cause symptoms such as fatigue, pale skin, or irregular heartbeat.

Hemoglobin

Causes

Certain illnesses will prompt your body to limit how much iron is freely available. This will prevent the infection or cancer from using the iron to grow. Unfortunately, iron is also needed to make healthy RBCs. Over time this will lead to fewer new red blood cells.

Long term illnesses that can lead to anemia, include

Chronic infections, such as tuberculosis , lung abscess, and subacute endocarditis
Noninfectious inflammatory diseases, such as rheumatoid arthritis , osteomyelitis , systemic lupus erythematosus , and inflammatory bowel disease
Common childhood infections, including ear infections and urinary tract infections
Congestive heart failure , thyroid disease, and kidney failure
Cancer, particularly Hodgkin’s disease , lung cancer , and breast cancer

Risk Factors

Anyone of any age with a chronic inflammatory or infectious disease may be at risk for ACD, but the elderly are among those at highest risk.

Symptoms

ACD usually develops slowly, producing few or no symptoms. When symptoms do occur, they are usually mild. Symptoms include:

Pale complexion, dizziness, fatigue, and rapid heartbeat
Infection, fever (even mild)

Diagnosis

Your doctor will ask about your symptoms and medical history, particularly any history of chronic inflammatory or infectious disease or cancer, and perform a physical exam. Blood tests may include:

Red blood cell count
Hemoglobin level
Serum iron level
Serum ferritin level
Serum transferrin receptor level
Transferrin iron binding capacity
Total iron binding capacity (TIBC)

Because iron stores will be elevated in the bone marrow, a bone marrow biopsy may also be performed.

Treatment

With ACD, if the underlying disease causing it is found and treated, the anemia may improve or clear on its own. Iron supplements and vitamins are generally not effective.

For severe cases of ACD, blood transfusions may be necessary. Another treatment is to give erythropoiesis-stimulating agents (ESAs), which help stimulate growth of new red blood cells. Examples of ESAs include epoetin and darbepoetin . These drugs do have risks that are important to consider before using them. There is some evidence that ESAs may shorten survival in cancer patients.

Prevention

If you have a chronic medical condition, continue prescribed treatment and maintain regular visits with your doctor.

RESOURCES

Iron Disorders Institute http://www.irondisorders.org/

National Anemia Action Council http://www.anemia.org/

CANADIAN RESOURCES

Anemia Institute http://www.anemiainstitute.org/

Canadian Cancer Society http://www.cancer.ca/

References

Anemia. Mayo Clinic.com website. Available at: http://www.mayoclinic.com/health/anemia/DS00321 . Updated March 2009. Accessed December 13, 2010.

Beutler E. Unlocking the mysteries of iron homeostasis and of the anemia of chronic disease: is hepcidin the key? Blood . 2003;102:775.

Merck Manual of Medical Information, Second Home Edition Online . Merck and Co, Inc. website. Available at http://www.merck.com/mmhe/index.html . Accessed July 15, 2005.

Weiss G, Goodnough, LT. Anemia of chronic disease. NEJM . 2005;352:1011-1023.

3/12/2008 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Bennett CL, Silver SM, Djulbegovic B, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA . 2008;299:914-924.

9/2/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Bohlius J, Schmidlin K, Brillant C, et al. Erythropoietin or Darbepoetin for patients with cancer—meta-analysis based on individual patient data. Cochrane Database Syst Rev . 2009;(3):CD007303.

Revision Information

Reviewer: Kari Kassir, MD
Review Date: 09/2012 -
Update Date: 03/28/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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