Anemia of Chronic Disease

Anemia of Chronic Disease is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Anemia of chronic disease (ACD) often develops in patients with long-standing inflammatory diseases, malignancy, autoimmune disorders, and chronic infection.
  • Etiology is multifactorial, including defective iron mobilization during erythropoiesis, inflammatory cytokine-mediated suppression of erythropoiesis, and impaired EPO response to anemia. Hepcidin is a critical regulator of iron homeostasis and is normally low when iron is deficient, allowing for increased iron absorption and utilization. Chronic inflammation increases hepcidin levels and causes a functional iron deficiency due to impaired iron recycling and utilization. Hepcidin is renally cleared, suggesting a role in anemia of chronic renal disease.1

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General Principles

  • Anemia of chronic disease (ACD) often develops in patients with long-standing inflammatory diseases, malignancy, autoimmune disorders, and chronic infection.
  • Etiology is multifactorial, including defective iron mobilization during erythropoiesis, inflammatory cytokine-mediated suppression of erythropoiesis, and impaired EPO response to anemia. Hepcidin is a critical regulator of iron homeostasis and is normally low when iron is deficient, allowing for increased iron absorption and utilization. Chronic inflammation increases hepcidin levels and causes a functional iron deficiency due to impaired iron recycling and utilization. Hepcidin is renally cleared, suggesting a role in anemia of chronic renal disease.1

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