(Anemia of Inflammation; Hypoferremia of Inflammatory Disease; ACD)
Certain long term medical conditions, such as cancer and infectious and inflammatory diseases can cause anemia. Anemia is a low level of healthy red blood cells (RBCs). RBCs carry oxygen from the lungs to the rest of the body. When red blood cells are low, the body does not get enough oxygen. This can cause symptoms such as fatigue, pale skin, or irregular heartbeat.
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Certain illnesses will prompt your body to limit how much iron is freely available. This will prevent the infection or cancer from using the iron to grow. Unfortunately, iron is also needed to make healthy RBCs. Over time, this will lead to fewer new red blood cells.
Long term illnesses that can lead to anemia, include
- Chronic infections, such as tuberculosis, lung abscess, and subacute endocarditis
- Noninfectious inflammatory diseases, such as rheumatoid arthritis, osteomyelitis, systemic lupus erythematosus, and inflammatory bowel disease
- Common childhood infections, including ear infections and urinary tract infections
- Congestive heart failure, thyroid disease, and kidney failure
- Cancer, particularly Hodgkin’s disease, lung cancer, and breast cancer
Anyone of any age with a chronic inflammatory or infectious disease may be at risk for ACD, but the elderly are among those at highest risk.
ACD usually develops slowly, producing few or no symptoms. When symptoms do occur, they are usually mild. Symptoms include:
- Pale complexion, lightheadedness, fatigue, and rapid heartbeat
You will be asked about your symptoms and medical history, particularly any history of chronic inflammatory or infectious disease or cancer. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:
- Blood tests
- A bone marrow biopsy
With ACD, if the underlying disease causing it is found and treated, the anemia may improve or clear on its own. Iron supplements and vitamins are generally not effective.
For severe cases of ACD, blood transfusions may be necessary. Another treatment is to give erythropoiesis-stimulating agents (ESAs), which help stimulate growth of new red blood cells. These drugs do have risks that are important to consider before using them. There is some evidence that ESAs may shorten survival in cancer patients.
If you have a chronic medical condition, continue prescribed treatment and maintain regular visits with your doctor.
National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov
Weiss G, Goodnough, LT. Anemia of chronic disease. NEJM. 2005;352:1011-1023.
What is anemia? National Heart Lung and Blood Institute website. Available at:
Updated May 18, 2012. Accessed August 19, 2014.
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Bennett CL, Silver SM, Djulbegovic B, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA. 2008;299:914-924.
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Bohlius J, Schmidlin K, Brillant C, et al. Erythropoietin or Darbepoetin for patients with cancer—meta-analysis based on individual patient data. Cochrane Database Syst Rev. 2009;(3):CD007303.
Last Updated: 8/19/2014