ABSTRACT
Anemia of chronic disease (ACD) is commonly seen secondary to a variety of medical conditions including rheumatoid arthritis, malignancies, chronic heart failure, acquired immunodeficiency syndrome (AIDS), and inflammatory bowel disease (IBD). The anemia of chronic disorders is characterized by a slightly shortened red cell life span, disturbed iron metabolism, and impaired erythropoietin-generated red cell production. The presence of a low serum iron level despite adequate iron stores indicates a profound disturbance of iron metabolism. The combination of a low serum iron level and transferrin saturation along with low total iron-binding capacity and normal or high ferritin levels have been used to differentiate
ACD from iron deficiency anemia. However, the diagnosis is often clouded by the elevation of serum ferritin in infection and inflammatory conditions. The production of the newly described hepcidin molecule is increased 100-fold in anemia of inflammation and this may lead to increased sequestration of iron in macrophages (1). (The differentiation of ACD from iron deficiency anemia is explained in detail elsewhere.)
Treating the underlying disease and red blood cell (RBC) transfusions have been the traditional therapies for symptomatic anemia until the last decade. The mainstay of successful therapy of anemia of chronic disease was, is, and will always be treatment of the underlying medical condition. Since the late 1980s, clinical studies have demonstrated some positive effects of erythropoietin on both hemoglobin values and patient symptoms for patients with ACD whose chronic disease cannot be adequately ameliorated. It is essential, however, to exclude other potentially correctable causes of anemia, including hemolysis, nutritional and hormonal deficiencies, hemoglobinopathies, red cell enzyme and structural defects, or bone marrow failure, prior to committing the patient with ACD to erythropoietic stimulants. In this section, we will focus on the mechanism and role of human recombinant erythropoietin in the treatment of ACD.
