Anemia Of Chronic Disease (ACD)
Anemia of Chronic Disease (ACD): Definition and Characteristics
What is Anemia of Chronic Disease (ACD)?
Anemia of Chronic Disease (ACD), also known as anemia of inflammation, is a type of anemia that develops in people with chronic medical conditions that cause prolonged inflammation. This condition results in a reduction of red blood cell production despite adequate iron stores in the body. It commonly occurs in chronic infections, autoimmune diseases, cancers, kidney disease, and other inflammatory states.
Characteristics
Mechanism
ACD results from several interacting mechanisms:
- Impaired red blood cell production due to decreased erythropoietin (EPO) synthesis and bone marrow responsiveness.
- Increased hepcidin levels induced by inflammatory cytokines (interleukin-1, interleukin-6, tumor necrosis factor-alpha), which inhibit iron absorption and trap iron within reticuloendothelial cells, making it unavailable for hemoglobin synthesis.
- Shortened red blood cell lifespan due to enhanced removal by macrophages during inflammation.
Symptoms
Symptoms are often mild or absent but may include fatigue, weakness, dizziness, shortness of breath, and pallor. Because the anemia develops gradually, many patients adapt to the symptoms.
Risk Factors
Chronic infections, autoimmune disorders (e.g., rheumatoid arthritis, lupus), malignancies, chronic kidney disease, and other inflammatory conditions significantly increase the risk of developing ACD.
Clinical Significance
ACD often complicates the underlying illness by worsening fatigue and functional status. Diagnosis relies on blood tests demonstrating low serum iron, low total iron-binding capacity, normal or increased ferritin, and reduced reticulocyte count, distinguishing it from iron deficiency anemia. Treatment focuses on managing the primary disease, with supplemental therapies like erythropoiesis-stimulating agents used selectively. Iron supplementation is generally ineffective unless there is documented iron deficiency.
Key Points
- Anemia of Chronic Disease is anemia associated with chronic inflammation or illness.
- Mechanisms include impaired erythropoiesis, iron sequestration by hepcidin, and shortened RBC survival.
- Symptoms are often subtle but worsen overall health and disease tolerance.
- Diagnosed by characteristic laboratory findings and managed by treating the underlying condition.
Consult with Our Team of Experts Now!
For accurate diagnosis and personalized treatment plans for anemia of chronic disease, consult our hematology and internal medicine specialists for comprehensive care utilizing Cellular Therapy and Stem Cells.
References:
- Weiss G, Goodnough LT. Anemia of Chronic Disease. N Engl J Med. 2005 Mar 10;352(10):1011-23. doi:10.1056/NEJMra041809. Available at: https://doi.org/10.1056/NEJMra041809
- de las Cuevas Allende R, et al. Anaemia of chronic diseases: pathophysiology, diagnosis, and treatment. Rev Clin Esp. 2021 Mar;221(3):144-152. doi:10.1016/j.rce.2020.11.007. Available at: https://doi.org/10.1016/j.rce.2020.11.007
- Madu AJ, Ughasoro MD. Anaemia of chronic disease: an in-depth review. Med Princ Pract. 2017;26(1):1-9. doi:10.1159/000453401. Available at: https://doi.org/10.1159/000453401
- Weiss G. Pathogenesis and treatment of anaemia of chronic disease. Blood Rev. 2020 Jan;39:100645. doi:10.1016/j.blre.2019.100645. Available at: https://doi.org/10.1016/j.blre.2019.100645
- National Institute of Diabetes and Digestive and Kidney Diseases. Anemia of Inflammation or Chronic Disease. 2025. Available at: https://www.niddk.nih.gov/health-information/blood-diseases/anemia-inflammation-chronic-disease
