The anemia of chronic disorders

When I was working at Bournemouth, one of my Wessex colleagues was Salisbury consultant haematologist Jonathan Cullis. He was an ex registrar from the Hammersmith hospital who had been there with my buddy, David Oscier. He has produced an excellent review of the anemia of chronic disease, which is obviously relevant for CLL sufferers so I am going to review this paper, step by step as a service to them.

Anemia of chronic disease (ACD), or anemia of inflammation, is the term used to describe the anemia with reduced red cell production seen in response to systemic illness or inflammation. It is the second most prevalent form of anemia after iron deficiency anemia (IDA) and the most common amongst patients with chronic illnesses. It is seen in a variety of conditions, including infections, cancer and autoimmune conditions. The anemia of chronic renal failure, although sometimes referred to as ACD, should not be included and will only be discussed to throw insights into other forms of ACD can be derived from relevant papers. ACD is typically normochromic and normocytic (but often microcytic), characterized by low serum iron, decreased transferrin saturation, decreased bone marrow sideroblasts and increased reticuloendothelial iron. The mechanisms that produce the anemia include impaired production of erythropoietin (EPO), blunted marrow erythroid response to EPO, iron-restricted erythropoiesis, and a diminished pool of EPO-responsive cells.

Among the conditions associated with ACD are viral, bacterial, parasitic and fungal infections, hematological and solid tumor malignancies, autoimmune conditions like rheumatoid arthritis, systemic lupus erythematosus, mixed connective tissue disease, vasculitis, polymyalgia, systemic sclerosis, polymyositis, sarcoidosis and inflammatory bowel disease, and some cardiac diseases such as chronic heart failure.