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Acd medical. Anemia of Chronic Disease: Causes, Symptoms, and Treatment Options

by alexxlab

What is anemia of chronic disease. How does it differ from other types of anemia. What are the common causes and risk factors. What symptoms should you watch out for. How is it diagnosed and treated. What complications can arise if left untreated.

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Understanding Anemia of Chronic Disease (ACD)

Anemia of chronic disease (ACD), also known as anemia of inflammation, is a common type of anemia that occurs in people with certain long-term medical conditions involving inflammation. Unlike other forms of anemia that result from deficiencies, ACD is caused by changes in the body triggered by chronic diseases.

ACD can develop when the body has trouble using iron to produce red blood cells, even when iron levels are normal. It may also occur if the bone marrow’s ability to make red blood cells is impaired or if red blood cells have a shortened lifespan. This complex condition highlights the intricate relationship between chronic illnesses and the body’s blood-forming processes.

How Does ACD Differ from Other Types of Anemia?

While many types of anemia result from nutritional deficiencies or blood loss, ACD is unique in that it stems from the body’s inflammatory response to chronic conditions. This distinction is crucial for proper diagnosis and treatment. Unlike iron-deficiency anemia, simply increasing iron intake may not resolve ACD.

Common Causes and Risk Factors for Anemia of Chronic Disease

ACD can be triggered by a wide range of chronic conditions that involve ongoing inflammation. Some of the most common causes include:

  • Autoimmune disorders (e.g., rheumatoid arthritis, lupus, inflammatory bowel disease)
  • Chronic infections (e.g., HIV/AIDS, tuberculosis, osteomyelitis)
  • Cancer, particularly lymphoma and Hodgkin’s disease
  • Chronic kidney disease
  • Chronic liver disease
  • Congestive heart failure

The risk of developing ACD increases with age and the duration of the underlying chronic condition. Individuals with multiple chronic diseases may be at higher risk of developing this type of anemia.

Recognizing the Symptoms of Anemia of Chronic Disease

ACD often develops gradually, and symptoms can be mild or even absent in some cases. When present, common symptoms may include:

  • Fatigue and weakness
  • Shortness of breath, especially during physical activity
  • Pale skin
  • Dizziness or lightheadedness
  • Rapid or irregular heartbeat
  • Difficulty concentrating
  • Chest pain

Is fatigue always a sign of anemia? While fatigue is a common symptom of anemia, it can be caused by many other conditions. It’s important to consult a healthcare provider for proper diagnosis if experiencing persistent fatigue or any combination of these symptoms.

Diagnostic Approaches for Anemia of Chronic Disease

Diagnosing ACD involves a combination of medical history review, physical examination, and laboratory tests. The diagnostic process typically includes:

  1. Complete blood count (CBC) to assess red blood cell levels and characteristics
  2. Serum ferritin and iron tests to evaluate iron storage and availability
  3. Reticulocyte count to measure the production of new red blood cells
  4. Inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
  5. Specific tests to identify or monitor the underlying chronic condition

In some cases, a bone marrow examination may be necessary to rule out other causes of anemia or to assess the bone marrow’s response to the chronic condition.

Challenges in Diagnosing ACD

Diagnosing ACD can be challenging due to its similarity to other types of anemia, particularly iron-deficiency anemia. How can doctors differentiate between ACD and iron-deficiency anemia? The key lies in analyzing iron studies and inflammatory markers. In ACD, ferritin levels are often normal or elevated, while in iron-deficiency anemia, they are typically low.

Treatment Strategies for Anemia of Chronic Disease

The primary approach to treating ACD is addressing the underlying chronic condition. However, specific treatments may be necessary to manage the anemia itself, especially in more severe cases. Treatment options may include:

  • Iron supplementation (in cases where iron deficiency coexists with ACD)
  • Erythropoiesis-stimulating agents (ESAs) to boost red blood cell production
  • Blood transfusions for severe anemia
  • Medications to reduce inflammation associated with the chronic condition

Can dietary changes help manage ACD? While a balanced diet rich in iron and other nutrients is important for overall health, dietary changes alone are usually not sufficient to treat ACD. The focus should be on managing the underlying chronic condition and following the treatment plan prescribed by a healthcare provider.

Potential Complications and Long-term Outlook

If left untreated, ACD can lead to various complications, including:

  • Decreased quality of life due to persistent fatigue and weakness
  • Increased risk of falls and fractures, especially in older adults
  • Cognitive impairment and decreased mental function
  • Cardiovascular complications, particularly in patients with pre-existing heart conditions
  • Reduced effectiveness of treatments for the underlying chronic condition

The long-term outlook for individuals with ACD largely depends on the management of the underlying chronic condition. With proper treatment of both the anemia and the chronic disease, many patients can experience significant improvement in their symptoms and overall quality of life.

Living with Anemia of Chronic Disease: Coping Strategies and Lifestyle Adjustments

Managing ACD often requires a multifaceted approach that extends beyond medical treatment. Patients can adopt several strategies to cope with the condition and improve their daily lives:

  • Regular exercise tailored to individual capabilities to improve energy levels and overall health
  • Adequate rest and stress management techniques to combat fatigue
  • Nutritious diet rich in iron, vitamin B12, and folate to support blood health
  • Staying hydrated to maintain proper blood volume
  • Avoiding tobacco and limiting alcohol consumption
  • Regular medical check-ups and adherence to treatment plans for both ACD and the underlying condition

How can patients effectively communicate their symptoms to healthcare providers? Keeping a symptom diary and noting any changes in energy levels, physical capabilities, or new symptoms can provide valuable information to healthcare providers and help in adjusting treatment plans as needed.

Research and Future Directions in ACD Management

Ongoing research in the field of ACD is focused on developing new treatment strategies and improving our understanding of the complex interplay between chronic diseases and anemia. Some promising areas of research include:

  • Novel iron-regulatory hormone therapies targeting hepcidin, a key protein in iron metabolism
  • Development of more effective and targeted anti-inflammatory treatments
  • Exploration of gene therapies to enhance red blood cell production
  • Investigation of the role of gut microbiota in iron absorption and inflammation

What potential breakthroughs can we expect in ACD treatment? While it’s difficult to predict specific breakthroughs, advancements in personalized medicine and a deeper understanding of the molecular mechanisms underlying ACD may lead to more targeted and effective treatments in the future.

The Importance of Awareness and Early Detection

Raising awareness about ACD among both healthcare providers and the general public is crucial for early detection and management. Key points to consider include:

  • Regular health check-ups, including blood tests, for individuals with chronic conditions
  • Education about the symptoms of anemia and when to seek medical attention
  • Improved communication between different medical specialties to ensure comprehensive care
  • Patient advocacy and support groups to share information and experiences

How can healthcare systems improve the detection and management of ACD? Implementing standardized screening protocols for anemia in patients with chronic diseases and promoting interdisciplinary collaboration can significantly enhance the detection and management of ACD.

In conclusion, anemia of chronic disease is a complex condition that requires a comprehensive approach to diagnosis and treatment. By understanding its causes, recognizing its symptoms, and working closely with healthcare providers, individuals with ACD can effectively manage their condition and improve their quality of life. As research continues to advance our understanding of this condition, we can look forward to more targeted and effective treatments in the future.

Anemia of chronic disease: MedlinePlus Medical Encyclopedia


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Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anemia.

Anemia of chronic disease (ACD) is anemia that is found in people with certain long-term (chronic) medical conditions that involve inflammation.

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

The 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 anemia or rule out other causes include:

  • Complete blood count
  • Reticulocyte count
  • Serum ferritin level
  • Serum iron level
  • C-reactive protein level
  • Erythrocyte sedimentation rate
  • Bone marrow examination (in rare cases to rule out cancer)

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 will 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.

Anemia of inflammation; Inflammatory anemia; AOCD; ACD

  • Blood cells

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.

Means RT. Approach to the anemias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 149.

Nayak L, Gardner LB, Little JA. Anemia of chronic diseases. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 37.

Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Anemia of Chronic Disease (ACD) – Health Information Library

  1. Red Blood Cells

Conditions Basics

What is anemia of chronic disease?

Having anemia means you don’t have enough red blood cells. Your body needs these cells to carry oxygen from your lungs to the rest of your body. Sometimes a long-term disease keeps your body from making enough red blood cells. This is called anemia of chronic disease, or ACD.

What causes it?

Anemia of chronic disease is caused by changes in the body that are triggered by a chronic disease. These changes can include:

  • A problem with using iron to make red blood cells, even when there’s enough iron in the body.
  • Bone marrow that can’t make red blood cells as well as it should.
  • Red blood cells that don’t live as long as they should.

One of the main causes of anemia of chronic disease is ongoing inflammation from autoimmune diseases such as rheumatoid arthritis, lupus, and inflammatory bowel disease. Other chronic conditions that can lead to anemia include diabetes, cancer, infection, and severe chronic kidney disease.

What are the symptoms?

You may find that anemia of chronic disease causes mild symptoms or no symptoms at all. If you do have symptoms, you may feel dizzy, tired, and weak. You may also feel your heart pounding or feel short of breath. It may be hard to focus and think clearly.

How is it diagnosed?

A blood test, sometimes done as part of a routine exam, tells your doctor if you have anemia. Your doctor may then do other tests to look for a cause.

Your doctor may diagnose you with anemia of chronic disease if:

  • You have a chronic disease or health problem that’s known to cause anemia.
  • Your symptoms and test results don’t point to other types of anemia, such as pernicious anemia, hemolytic anemia, or iron deficiency anemia.

How is anemia of chronic disease treated?

Anemia of chronic disease (ACD) is most often treated by treating the health problem that caused it. For example, treating rheumatoid arthritis can lower inflammation, which can then improve ACD.

For ACD caused by cancer or chronic kidney disease, medicine can help the body make more red blood cells. These medicines are called erythropoietin stimulating agents, or ESAs.

Severe anemia is treated with a blood transfusion of red blood cells, no matter what the cause is.

Only take iron if your doctor tells you to. Unless you also have iron deficiency anemia, taking iron does not help with ACD. If your iron level is normal, taking extra iron can be dangerous.

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