What Is Anemia of Chronic Disease?

Anemia of chronic disease (ACD) refers to having low levels of red blood cells resulting from any number of chronic diseases including autoimmune diseases, cancers, and long-term infections. With this type of anemia, a person will have normal or increased levels of iron stored in body tissues, and low levels of iron in the blood. This is because inflammation prevents the body from using stored iron and making enough healthy blood cells. ACD is also called anemia of inflammation.

Anemia of Chronic Disease Symptoms

There are many different types of anemia, and anemia of chronic disease is the second most common type. The symptoms of ACD are similar to what is caused by iron-deficiency anemia and may include:

• Feeling tired or weak
• Pale skin
• Shortness of breath, chest pain, or rapid heartbeat
• Sweating
• Cold hands and feet
• Feeling dizzy or faint
• Headaches
• Brittle nails
• Poor appetite
• Inflammation in the tongue
• Pica—a craving to eat non-food items, such as dirt or sand

Some people have no symptoms, others have many, and some only seem to have symptoms when they are exercising.

Causes

The mechanisms that cause anemia of chronic disease are several, and may vary depending what underlying condition the person has. Some chronic diseases cause changes to red blood cells—the oxygen-carrying red blood cells made by the bone marrow—that cause them to die sooner.

Other conditions may result in slowing down of normal red blood cell production. With kidney disease, this happens because the production of the hormone erythropoietin (EPO) that stimulates the marrow to make red blood cells is impaired.

Additionally, the iron that would normally be recycled from old red cells may be held within a system of cells called macrophages. This eventually leads to a limited amount of iron for creating new red blood cells, where it is necessary for making hemoglobin, the compound responsible for carrying oxygen. The way iron is metabolized also becomes impaired.

Conditions that increase a person’s risk for anemia of chronic disease are:

• Autoimmune diseases that cause inflammation, such as systemic lupus erythematosus (SLE), rheumatoid arthritis, and ulcerative colitis. These conditions are ones in which the body’s immune system attacks its own healthy tissues, including joints and body organs, through an inflammatory response process.
• Most cancers can lead to anemia of chronic disease and it is roughly proportional to the tumor burden
• Long term infections, such as osteomyelitis (bone infection) or bacterial endocarditis (infection of the inner lining of the heart, usually including the heart valves)
• Other chronic conditions, such as heart disease, kidney disease, and diabetes. A 2019 report in the journal PLoS One notes that both severe kidney disease and diabetes are most associated with ACD.

Diagnosis

The symptoms of many chronic diseases can mimic the symptoms of ACD. When you are feeling badly, your healthcare provider will want to perform some tests to determine whether ACD is the cause or whether it is due to your chronic illness or some other health condition.

Tests that can help diagnose anemia of chronic disease and other possible causes of symptoms include:

Complete blood count (CBC): This blood test looks at the number and size of red blood cells and the amount of hemoglobin (the protein responsible for producing oxygen in the blood) in the blood and in red blood cells.

A blood smear: This test may be used to examine the shape, size, and number of red blood cells. It is often performed along with the CBC.

Serum ferritin level: This blood test measures the level of ferritin, a major iron storage protein of the body.

Serum iron level: The serum iron test measures how much iron is in the serum, the liquid remaining from the blood when red blood cells and clotting factors are removed. This test can reveal abnormally high or low levels of iron.

Bone marrow biopsy: A bone marrow biopsy is done in an outpatient setting, using light sedation or general anesthesia. The clinician will insert a needle into the pelvis to collect a sample of bone marrow. Increased iron in the bone marrow, in addition to low serum levels, indicates ACD.

Treatment

Anemia of chronic disease is usually treated by managing the underlying chronic condition that caused it. For example, for people with inflammatory arthritis, reducing inflammation levels can improve ACD.

When ACD is caused by cancer or chronic kidney disease, medications called erythropoietin stimulating agents (ESAs) can help the body to produce more red blood cells. These treatments are available as a subcutaneous (under the skin) injections. Your healthcare provider will check hemoglobin levels every few weeks to determine if ESA treatment is helping.

Severe anemia is treated with a blood transfusion of red blood cells. This is only done in rare situations. Transfusion treatment is a short-term solution because it is associated with risks, including iron overload and the risk of infection, especially in people with autoimmune diseases.

Prevention

It is not possible to prevent anemia of chronic disease. For people with inflammatory chronic diseases, the management of these conditions may reduce or prevent inflammation that leads to ACD. You should talk to your healthcare provider if you are concerned about ACD and treatments that may help reduce high levels of inflammation. Make sure you follow the treatment plan your practitioner has recommended.

A Word From Verywell

The outlook for people with anemia of chronic disease is usually good. If you have a chronic disease associated with ACD and think you may be anemic, talk to your healthcare provider about bloodwork for anemia. If bloodwork shows ACD, your practitioner will recommend treatment options to reduce the underlying inflammation and also what to do if symptoms of ACD don’t improve.

Anemia of chronic disease needs diagnosis and treatment, and it is not something you can treat on your own with iron supplements. Therefore, if you or your child develop symptoms of ACD, it is vital that you see a medical professional.