Anemia of chronic disease

Anemia is a lower-than-normal number of red blood cells in the blood. ACD is a common cause of anemia. Some conditions that can lead to ACD include:

• Autoimmune disorders, such as Crohn disease, systemic lupus erythematosus, rheumatoid arthritis, and ulcerative colitis
• Cancer, including lymphoma and Hodgkin disease
• Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS, lung abscess, hepatitis B or hepatitis C

Anemia of chronic disease is often mild. You may not notice any symptoms.

When symptoms occur, they may include:

• Feeling weak or tired
• Headache
• Paleness
• Shortness of breath

Your health care provider will perform a physical exam.

Anemia may be the first symptom of a serious illness, so finding its cause is very important.

Tests that may be done to diagnose ACD include:

• Complete blood count (CBC)
• Reticulocyte count
• Serum ferritin level
• Serum iron level
• C-reactive protein level
• Erythrocyte sedimentation rate
• Bone marrow aspiration (in rare cases to check for cancer)

In people with ACD, the anemia is often mild enough that it does not need treatment. It may get better when the disease that is causing it is treated.

More severe anemia, such as that caused by cancer or HIV/AIDS may require:

• Blood transfusion
• Erythropoietin, a hormone produced by the kidneys, given as a shot

The anemia may improve when the disease that is causing it is treated.

Discomfort from symptoms is the main complication in most cases. Anemia may lead to a higher risk for death in people with heart failure.

Contact your provider if you have a long-term (chronic) disorder and you develop symptoms of anemia.

If you have a chronic disease, take steps your provider recommends to treat it.

Anemia of inflammation; Inflammatory anemia; AOCD; ACD; Anemia of chronic inflammation

Elghetany MT, Banki K. Erythrocytic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 33.

Ginzburg YZ. Anemia of chronic inflammation. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 38.

Means RT Jr. Approach to the anemias. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 144.

Updated by: Warren Brenner, MD, Oncologist, Lynn Cancer Institute, Boca Raton, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.