ABSTRACT
Anemia of chronic disease (ACD) is defined as the anemia associated with infection, inflammation, cancer, or trauma that has the characteristic picture of hypoferremia, hyperferritinemia, decreased transferrin concentration, and increased iron stores (1). The pathogenesis of ACD involves the combination of a shortened erythrocyte survival in circulation with failure of the bone marrow to increase red cell production
in compensation (2-7). Inappropriate red cell production is itself related to a combination of factors, including impaired availability of storage iron, inadequate erythropoietin (Epo) response to anemia, and overproduction of cytokines, which are capable of inhibiting erythropoiesis (2-5). These cytokines are involved in the retention of iron in the reticuloendothelial system, gastrointestinal tract, and hepatocytes. Theymay interfere with Epo production by the kidney, and may exert direct inhibitory effects on erythroid precursors (3,4,8-12). Indeed, their effect is much wider, involving the whole hematopoietic system (13).
