Anaemia of chronic disease

Page 1 2 3

What is Anaemia of chronic disease?

Anaemia is a condition where there is a low level of a substance called haemoglobin in the blood. This haemoglobin is responsible for the transport of oxygen around the blood within red blood cells. The most common cause is a low level of iron (iron deficiency anaemia), which is required to create the haemoglobin. The second most common cause is anaemia of chronic disease.

Anaemia of chronic disease is a condition where the anaemia is actually caused by a long-term inflammation that is present is many different types of diseases. When you get inflammation, the body releases lots of different chemicals (called 'cytokines') into the blood stream which help the body to heal itself. If inflammation is present for a very long time however, then these cytokines can affect the production of haemoglobin and lead to anaemia.

They do this in several different ways. Firstly, several of the chemicals lower the production of a hormone (a kind of signalling chemical) called 'erythropoietin'. Erythropoietin signals to the body to increase the production of red blood cells and haemoglobin, and so since these inflammatory cytokines lower how much is being produced, it can lead to anaemia.

Another product of inflammation is the production of a chemical called 'hepcidin' which is created by the liver and stops iron from being absorbed in the intestines, and without iron haemoglobin cannot form.

Some of the cytokines can also cause the immune system to gobble up more of the iron that is in the blood, as well as destroying the red blood cells earlier and absorbing the iron within them into the immune cells. The immune cells also change their structure so that it is harder to actually get iron out of them, meaning that it is locked inside and not accessible by other parts of the body.

Who gets Anaemia of chronic disease?

Anaemia of chronic disease is the second most common type of anaemia, behind only iron deficiency anaemia and it may be the most common cause of anaemia for hospitalised patients.

The rates for some conditions are as follows:

Up to 95% of patients with an acute or chronic infection
Up to 77% of cancer patients
Up to 81% of people with autoimmune conditions
Up to 70% of patients who have rejection following an organ transplant
Up to 50% of patients with chronic kidney disease and inflammation

Predisposing Factors

There are some diseases in particular that can lead to anaemia of chronic disease, such as:

Chronic infections such as:
- Osteomyelitis (an infection of the bone)
- Infective endocarditis (an infection of the heart valves) and
- Lung abscess
Immune disorders such as:
Cancers

Progression

Anaemia of chronic disease appears gradually during the course of the underlying disease causing the condition. It improves with effective management of the chronic disease.

Page 1 2 3