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ANEMIA OFANEMIA OF

CHRONIC DISEASECHRONIC DISEASE

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DEFINITION

* Anemia associated with chronic infection, inflammatory

disease, or neoplastic disease

* 1 to 2 months of sustained disease is required for 

anemia to develop.* Anemia is moderate, with a Hb level beetwen 7 and 11

g/dl and rarely symptomatic

* Common features are

- Low serum iron level

- Low serum TIBC

- Increased marrow iron stores

- Reduced rate of red cell production

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PATHOGENESIS

* Red cell life span is reduced by 20 to 30 %

* Impaired release of iron from macrophages leads to a

low level of serum iron and consequent low saturation

of transferrin

* Prduction of erythropoietin (EPO) is decreased is

response to anemia and the erythroid precursors to

respond to EPO is impaired

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CLINICAL AND LABORATORY

FEATURES

* Anemia is usually overshadowed by symptoms of the primary

disease

* Diagnosis depends on laboratory findings:

- Initially normochronic, normocytic anemia, hypochromic,

microcytic features develop as disease progresses

- Low serum iron level and somewhat decreased serum

transferrin concentration: decreased % saturation of transferrin

- Level serum ferritin, an acute phase protein, inappropriately

elevated with respect to storage iron- Bone marrow contains increased storage iron. The M/E ratio is

normal, and the % of sideroblast is decreased

- In iron deficiency anemia, low serum iron, increased

transferrin, decreased storage iron and serum ferritin

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DIFFERENTIAL DIAGNOSIS

* Dilution anemia, in patient with far advanced neoplastic

disease

* Drug-induced marrow suppression, or drug-induced

hemolysis

* Iron dificiency anemia

* Anemia of chronic renal failure

* Myelophthisic anemia, due carcinoma or lymphoma

replacing marrow

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THERAPY

* No treatment may be necessary

* Iron is contraindicatede

* Cobalt chlorine ang androgenic steroid may be of 

 benefit but have unacceptable side effect* Paked red cell transfussion may be given, if anemia

is sympomatic

* EPO therapy is effective