Anemia of Chronic Disease

Overview

What is anemia of chronic disease?

Anemia of chronic disease happens when you have an autoimmune disease or other illness lasts longer than three months and that causes inflammation. (Providers may use the term anemia of inflammation or anemia of inflammation and chronic disease). Chronic inflammation can affect your body’s ability to use iron needed to make enough red blood cells. Anemia happens when you don’t have enough red blood cells. Most of the people who have anemia of chronic disease have a mild form of the condition. Healthcare providers treat anemia of chronic disease by treating the underlying condition.

Who is affected by anemia of chronic disease?

Like its name, anemia of chronic disease may affect anyone who has a chronic illness. Anyone who has a chronic illness may develop anemia of chronic disease. That said, most of the people who have this condition are age 65 and older. Studies indicate about 1 million people in the United States age 65 and older have anemia of chronic disease. Diseases that may cause anemia of chronic disease include:

What autoimmune diseases cause anemia of chronic disease?

The following autoimmune diseases may cause anemia of chronic disease:

What conditions may cause anemia of chronic disease?

Anemia of chronic disease is linked to:

How common is this condition?

It's the second most common type of anemia, after iron-deficiency anemia.

Symptoms and Causes

What are the symptoms of anemia of chronic disease?

Anemia of chronic disease symptoms are like symptoms of iron-deficiency anemia. Not everyone who has anemia of chronic disease will notice symptoms. Some people may only notice symptoms when they’re exercising. People who do have symptoms even when they aren’t exercising may:

  • Feel very tired or weak. They may feel too weak to manage their day-to-day activities.
  • Feel short of breath.
  • Notice their skin is more pale than usual.
  • Feel sweaty for no reason.
  • Feel dizzy or faint.
  • Have headaches.

What is the most common cause of anemia of chronic disease?

Any chronic disease that causes inflammation is likely to cause anemia of chronic disease. If you have a chronic disease, your disease may affect your red blood cells. These are blood cells carrying oxygen throughout your body.

Your bone marrow is constantly making new red blood cells to replace dying or damaged red blood cells. Most red blood cells live for about 120 days. A chronic disease may make red blood cells die sooner than usual or slow down red blood cell production. Here’s how a chronic disease may change your red blood cells:

  • Your body normally recycles the iron in old red blood cells to make new red blood cells. In anemia of chronic disease, a system of cells called macrophages traps the recycled iron. That means your body has less iron to help create new red blood cells.
  • Anemia of chronic disease affects how your cells metabolize iron.

Why is iron low in anemia of chronic disease?

If you have anemia of chronic disease, some of your cells are retaining iron instead of releasing it, so your body can’t use it to create new red blood cells.

Diagnosis and Tests

How do healthcare providers diagnose anemia of chronic disease?

Providers typically do blood tests to find out if anemia of chronic disease is causing your anemia.

What lab values indicate anemia of chronic disease?

Healthcare providers evaluate several lab test results to diagnose anemia of chronic disease. Here’s what your blood test may show:

  • Your hemoglobin level. Hemoglobin gives red blood cells their color. The normal hemoglobin range is 12 to 17.4 grams per deciliter of blood. If your hemoglobin level is low, your provider may also check your erythropoietin (EPO) level. EPO is a hormone your kidneys make to help your bone marrow make red blood cells.
  • Your serum iron level. Serum is a liquid part of blood. This test measures the amount of iron in your blood. The normal value range is 60 to 170 micrograms per deciliter of blood.
  • Your reticulocyte count: Reticulocytes are immature red blood cells. A low reticulocyte count may mean your bone marrow isn’t producing as many red blood cells as usual.
  • Your iron-binding capacity. This test shows if you have too much or too little iron in your blood. The normal range for adults is 250 to 450 micrograms per deciliter of blood.
  • Your serum ferritin level: Ferritin is a blood protein that contains iron. This test shows how much iron your body stores. Normal ferritin levels range from 20 to 200/500 nanograms per millimeter of blood.

What other tests do providers use to diagnose anemia of chronic disease?

Your provider may perform a bone marrow biopsy so they can test for iron stores and serum iron levels. High iron stores and a low serum iron level may be a sign you have anemia of chronic disease.

Management and Treatment

How do you correct anemia of chronic disease?

Treatment depends on the underlying disease that caused anemia. Many times treating the underlying disease eliminates the anemia and its symptoms. People who have anemia caused by cancer or chronic kidney disease may need different or additional treatment. Here are some treatment options:

  • Blood transfusion: Providers may use blood transfusions as a short-term therapy to help people who have severe anemia. Blood transfusions aren’t a long-term solution, given side effects that include iron overload and risk of infection.
  • Synthetic EPO therapy: This treatment boosts your EPO levels. EPO is a hormone your kidneys make to help your bone marrow make red blood cells.
  • Iron supplements: Providers may combine EPO therapy and iron supplement therapy.

Prevention

How can I reduce my risk of developing anemia of chronic disease?

Anemia of chronic disease happens because you have a chronic illness that affects your red blood cell levels. You may not be able to prevent anemia, but you can help your overall health by eating a healthy diet that includes:

  • Lean protein including chicken, turkey and beans.
  • Dark leafy greens like spinach and kale.
  • Iron-fortified bread and cereal.
  • Vitamin supplements including B12, folate and iron.

Outlook / Prognosis

What can I expect if I have anemia of chronic disease?

Many times providers successfully treat anemia of chronic disease by treating the underlying condition.

A note from Cleveland Clinic

If you have anemia of chronic disease, you’re already dealing with a long-term illness with its own challenges. If that’s your situation, you may feel exhausted because you have anemia and because anemia is one more medical condition that you need to manage. Fortunately, most cases of anemia of chronic disease have mild or moderate symptoms that clear up with treatment. Once you’ve completed treatment, you may want to ask your healthcare provider about lifestyle changes —things like diet and exercise — that may help reduce your risk of developing another case of anemia of chronic disease.

Last reviewed by a Cleveland Clinic medical professional on 04/07/2022.

References

  • Cullis, J. Anaemia of chronic disease. Clin Med (Lond). 2013 Apr;13(2):193-6. Accessed 3/9/2022.
  • Fraenkel, PG. Understanding anemia of chronic disease. Hematology Am Soc Hematol Educ Program. 2015;2015:14-8. Accessed 3/9/2022.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Anemia of Inflammation & Chronic Disease. Accessed 3/9/2022.
  • Nemeth E, Ganz T. Anemia of inflammation. Hematology/Oncology Clinics of North America. _2014;28(4):671–681. Accessed 3/9/2022.
  • Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Med Princ Pract. 2017;26(1):1-9. Accessed 3/9/2022.

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