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anemia of chronic disease (ACD)

Etiology: 1) anemia of chronic inflammation 2) anemia of uremia (renal failure) 3) anemia of endocrine failure 4) anemia of chronic liver disease Epidemiology: - common Laboratory: 1) hematology - complete blood count (CBC) - hemoglobin is low (but > 9 g/dL) - MCV generally normal - absolute reticulocyte count is low 2) peripheral blood - normochromia or hypochromia - normocytic, but may be hypochromic 3) serum chemistries - decreased serum iron - decreased total iron-binding capacity (TIBC) - anemia of chronic renal failure - serum creatine may be high - serum erythropoietin may be low - serum ferritin in high in anemia of chronic inflammation Management: - treatment is primarily aimed at treatment of the underlying disorder - erythropoiesis-stimulating agents (ESA) - erythropoiesis-stimulating agents & cancer are both associated with an increased risk of thrombosis - weigh risk of venous thromboembolism against potential benefit prior to use of ESAs - ESAs may be acceptable for patients with low-risk myelodysplastic syndrome - await best treatment response before using ESAs in patients with myeloma, non-Hodgkin lymphoma, or chronic lymphocytic leukemia - target blood hemoglobin is the lowest that prevents need for transfusion - discontinue transfusion if lack of Hgb increase by 1-2 g/dL by 6-8 weeks - iron studies with iron replacement witheither oral or intravenous iron

Interactions

disease interactions

Specific

anemia of chronic inflammation anemia of chronic liver disease anemia of chronic renal failure anemia of endocrine failure

General

chronic hematologic disease (chronic blood disorder) hypoplastic anemia

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1732
  2. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018.
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  4. Guralnik JM1, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004 Oct 15;104(8):2263-8. Epub 2004 Jul 6 PMID: 15238427
  5. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005 Mar 10;352(10):1011-23. PMID: 15758012
  6. Bohlius J, Bohlke K, Castelli R et al. Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update. Blood Adv 2019 Apr 23; 3:1197 PMID: 30971397 Free PMC Article http://www.bloodadvances.org/content/3/8/1197
  7. ARUP Consult: Anemia of Chronic Disease - Anemia of Inflammation The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/anemia-chronic-disease-anemia-inflammation