anemia of chronic disease (ACD)
Jump to navigation
Jump to search
Etiology
- anemia of chronic inflammation
- anemia of uremia (renal failure)
- anemia of endocrine failure
- anemia of chronic liver disease
Epidemiology
- common
Laboratory
- hematology
- complete blood count (CBC)
- hemoglobin is low (but > 9 g/dL)
- MCV generally normal
- absolute reticulocyte count is low
- complete blood count (CBC)
- peripheral blood
- normochromia or hypochromia
- normocytic, but may be hypochromic
- 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
More general terms
More specific terms
- anemia of chronic inflammation
- anemia of chronic liver disease
- anemia of chronic renal failure
- anemia of endocrine failure
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1732
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018.
- ↑ Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/15238427
- ↑ Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005 Mar 10;352(10):1011-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15758012
- ↑ 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30971397 Free PMC Article <Internet> http://www.bloodadvances.org/content/3/8/1197
- ↑ 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