TY - CHAP M1 - Book, Section TI - Anemia of Chronic Disease A1 - Ganz, Tomas A2 - Kaushansky, Kenneth A2 - Lichtman, Marshall A. A2 - Prchal, Josef T. A2 - Levi, Marcel M. A2 - Press, Oliver W. A2 - Burns, Linda J. A2 - Caligiuri, Michael PY - 2015 T2 - Williams Hematology, 9e AB - SUMMARYMost patients suffering from chronic infection, chronic inflammation, or some with various malignancies develop a mild to moderate anemia. This anemia, designated anemia of chronic disease or anemia of chronic inflammation, is characterized by a low serum iron level, a low to normal transferrin level, and a high to normal ferritin level. The anemia is caused by the direct and indirect inhibitory effects of inflammatory cytokines on erythrocyte production. Among the cytokines, interleukin-6 has a central role, acting by increasing hepatocyte production of the iron-regulatory hormone hepcidin. Hepcidin then blocks the release of iron from macrophages and hepatocytes, causing the characteristic hypoferremia associated with this anemia, and limiting the availability of iron to the developing erythrocytes. Effective treatment of the underlying disease restores normal erythropoiesis. When this is not possible, and treatment is necessary, therapeutic trials have revealed that the anemia is often responsive to pharmacologic doses of erythropoietin.Anemia of chronic kidney disease presents similarly to anemia of inflammation but because the kidneys are the predominant site of erythropoietin production, the pathogenesis of this anemia is frequently dominated by relative erythropoietin deficiency, where erythropoietin concentrations in serum are lower than expected for the severity of anemia. Systemic inflammation from underlying renal disease, or induced by dialysis treatments and their complications, contributes to pathogenesis in a manner similar to anemia of inflammation. Circulating hepcidin concentrations may also rise because of its decreased renal clearance. Suppressive effects of uremia on erythropoiesis and blood losses from hemodialysis may contribute to anemia in end-stage renal disease. A combination of erythropoiesis–stimulating agents and intravenous iron is usually effective in reversing anemia but overtreatment may worsen overall outcomes. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1121091922 ER -