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Anemia of Chronic Disease (Anemia of Inflammation)

Functional Iron-Restricted Erythropoiesis from Sustained Inflammatory Activity

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Hematoloji department. Book Appointment →

What is Anemia of Chronic Disease (Anemia of Inflammation)?

Anemia of chronic disease (ACD), also known as anemia of inflammation, is the second most common anemia worldwide and the most common in hospitalized patients.

It develops in chronic inflammatory conditions such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, chronic infections (tuberculosis, osteomyelitis, HIV), and malignancies.

The pathophysiology centers on cytokine-driven (IL-6) hepcidin upregulation, which blocks iron release from macrophages and enterocytes, shortening red cell lifespan and blunting erythropoietin response.

Symptoms

Mild to moderate fatigue, pallor, and reduced exercise tolerance
Underlying chronic disease symptoms (joint pain, fever, weight loss) usually predominate
Generally hemoglobin remains 8-10 g/dL with normocytic indices
Microcytosis may emerge in long-standing inflammation, mimicking iron deficiency
Tachycardia and dyspnea on exertion in advanced cases

Risk Factors

Active rheumatoid arthritis or other autoimmune disease
Chronic infections (HIV, hepatitis C, tuberculosis, endocarditis)
Solid tumors and hematologic malignancies
Chronic kidney disease (overlap syndrome)
Heart failure with chronic systemic inflammation
Long-term inflammatory bowel disease

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent normocytic anemia in known inflammatory disease
  • Worsening fatigue or new exertional symptoms in chronic illness
  • Hemoglobin under 10 g/dL despite stable disease control
  • New iron studies showing low serum iron with normal/elevated ferritin
  • Anemia not responding to oral iron supplementation

Treatment Methods

01
Treat the underlying inflammatory disorder — disease control restores erythropoiesis
02
Intravenous iron when functional iron deficiency coexists (transferrin saturation under 20% with elevated ferritin)
03
Erythropoiesis-stimulating agents (ESAs) for chronic kidney disease and chemotherapy-induced anemia
04
Red cell transfusion only for symptomatic severe anemia
05
Avoid oral iron — poor absorption due to high hepcidin
06
Emerging therapies: hepcidin antagonists, hypoxia-inducible factor stabilizers (roxadustat)
07
Multidisciplinary management with rheumatology, oncology, or infectious disease specialists

Which Department to Visit?

You can visit our Hematoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.