J Korean Med Assoc.  2006 Oct;49(10):920-926. 10.5124/jkma.2006.49.10.920.

Anemia of Chronic Disease

Affiliations
  • 1Department of Internal Medicine, Inha University College of Medicine, Korea. cskimmd@inha.ac.kr

Abstract

Although anemia of chronic disease (ACD) is the most prevalent form of anemia next to iron deficiency anemia, its significance has been overridden by the dominant manifestation of the underlying diseases, i.e. chronic inflammation, infection, organ failure, or malignancy. As the treatment of ACD is being recognized to be important for the restoration of life quality, clinicians should be aware of how to detect, how to discriminate, and how to treat the disease. The key pathophysiology of ACD lies on the trapping of iron in the reticuloendothelial system by pro-inflammatory cytokines. The best treatment of ACD is the treatment of underlying disease per se, which is unfeasible in a substantial portion of the cases. Blood transfusion is occasionally harmful without altering the natural course of underlying disease. The benefit of erythropoietin (EPO) was already established in chronic renal disease. EPO has emerged as an important palliative measure for anemia in a variety of cancers. Augmented supplement of EPO may overcome the blunted response to physiologic EPO in anemia secondary to chronic infection or inflammation. Functional or absolute iron deficiency in ACD is manageable using EPO in conjunction with parenteral iron supplement. The iron deficiency in ACD can be identified by low ferritin value (<30 ug/L) or a high ratio of soluble transferrin receptor/log ferritin (>2). Further studies are required for the elucidation of molecular pathogenesis, more accurate diagnosis and new treatment to mobilize trapped iron into active erythropoiesis. The judicious use of therapeutic options currently available can result in palliation of ACD in a majority of the patients, and every single clinician should be fully aware of the principles behind the palliative measures.

Keyword

Anemia; Chronic disease; Erythropoietin; Iron; Ferritin; Soluble transferrin receptor

MeSH Terms

Anemia*
Anemia, Iron-Deficiency
Blood Transfusion
Chronic Disease*
Cytokines
Diagnosis
Erythropoiesis
Erythropoietin
Ferritins
Humans
Inflammation
Iron
Mononuclear Phagocyte System
Quality of Life
Renal Insufficiency, Chronic
Transferrin
Cytokines
Erythropoietin
Ferritins
Iron
Transferrin

Reference

1. Cavill I, Auerbach M, Bailie GR, Barrett-Lee P, Beguin Y, Wilson K, et al. Iron and the anaemia of chronic disease: a review and strategic recommendations. Curr Med Res Opin. 2006. 22:731–737.
Article
2. Thomas C, Kirschbaum A, Boehm D, Thomas L. The diagnostic plot: a concept for identifying different states of iron deficiency and monitoring the response to epoetin therapy. Med Oncol. 2006. 23:23–36.
Article
3. Ganz T. Molecular pathogenesis of anemia of chronic disease. Pediatr Blood Cancer. 2006. 46:554–557.
Article
4. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005. 352:1011–1023.
Article
5. Korean Society of Hematology. Hematology. 2006. 1st ed. E-Public;68–71.
6. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med. 2001. 345:1230–1236.
Article
7. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Peres-Bota D, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002. 288:1499–1507.
Article
8. Weiss G, Gordeuk VR. Benefits and risks of iron therapy for chronic anaemias. Eur J Clin Invest. 2005. 35:Suppl 3. 36–45.
Article
9. Nissenson AR, Swan SK, Lindberg JS, Soroka SD, Beatey R, Maroni BJ, et al. Randomized, controlled trial of darbepoetin alfa for the treatment of anemia in hemodialysis patients. Am J Kidney Dis. 2002. 07. 40:110–118.
Article
10. Kaltwasser JP, Kessler U, Gottschalk R, Stucki G, Moller B. Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. J Rheumatol. 2001. 28:2430–2436.
11. Weiss G, Meusburger E, Radacher G, Garimorth K, Neyer U, Mayer G. Effect of iron treatment on circulating cytokine levels in ESRD patients receiving recombinant human erythropoietin. Kidney Int. 2003. 64:572–578.
Article
12. Bokemeyer C, Aapro MS, Courdi A, Foubert J, Link H, Soubeyran P, et al. EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer. Eur J Cancer. 2004. 40:2201–2216.
Article
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