Haema 2016; 7(3): 294-304
by Konstantina Papathanasiou, Eleftheria Hatzimichael
Department of Haematology, University Hospital of Ioannina, Ioannina, Greece
Abstract
Anemia of chronic disease (ACD) is the most common anemia among hospitalized patients and the second most common after iron deficiency anemia worldwide. Recently, the term «anemia of inflammation» is being used as it better reflects the underlying pathophysiology of ACD. The major causes are acute and chronic infections, inflammatory diseases, autoimmune disorders such as rheumatoid arthritis, neoplasms (solid and hematological malignancies), chronic renal disease etc. ACD is an immune mediated anemia resulting from the action of cytokines and acute phase proteins with hepcidin playing the most important role. The main pathophysiological mechanisms involved in ACD are: a) abnormal iron metabolism with reduced absorption of iron from the gastrointestinal tract and trapping of iron in- macrophages, b) relative decrease in erythropoietin production and resistance of erythroid progenitor cells to erythropoietin action, c) reduced erythropoiesis, d) decreasedred cell survival and e) hemophagocytosis. ACD is a diagnosis of exclusion and should be deferentially diagnosed from other anemias. The degree of anemia is mostly mild and no therapeutic interventions are required. Treatment is needed when: the degree of anemia becomes more severe, increasing the cardiovascular risk and affecting patients’ quality of life and b) in moderate anemia when there is a concurrent coronary heart disease, respiratory disease, chronic renal failure and age over 65 years. The main therapy for ACD is correction of the underlying Additional therapeutic methods widely used are red blood cell transfusions, erythropoietin and correction of the functional iron deficiency. Over the last decade, the increasing knowledge on the pathophysiology of ACD, resulted in development of new promising targeted therapies, mainly hepcidinantagonists that have proved effective in animal models and some are already in clinical trials.