Anaemia of chronic disease
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- systemic symptoms of underlying condition
- absent history of bleeding
- physical finding suggesting infection
- physical finding suggesting neoplasm
- physical finding suggesting autoimmune disorder
Other diagnostic factors
- absent history of high alcohol intake
- absent history of exposure to chemicals and radiation
- absent history of drugs known to be associated with risk of anaemia
- absent history of poor nutrition
- decreased exercise tolerance
- shortness of breath with exercise
- fatigue
- pallor
Risk factors
- autoimmune disorders
- malignancy
- acute or chronic infection
- critical illness, major trauma, or major surgery with delayed recovery
- chronic disease
Diagnostic investigations
1st investigations to order
- Hb
- WBC and differential
- platelet count
- mean corpuscular volume (MCV)
- mean corpuscular haemoglobin concentration (MCHC)
- peripheral blood smear
- serum ferritin
- serum iron
- total iron-binding capacity
- transferrin saturation
- absolute reticulocyte count
- serum creatinine
Investigations to consider
- C-reactive protein (CRP)
- erythrocyte sedimentation rate
- serum B12
- serum folate
- thyroid function tests
- LFTs
- indirect and direct bilirubin
- LDH
- erythropoietin
- haemoglobin electrophoresis
- bone marrow biopsy
- soluble transferrin receptor
- ratio of soluble transferrin receptor to log ferritin
Treatment algorithm
mild to moderate anaemia (haemoglobin [Hb] 80 to 110 g/L [8 to 11 g/dL])
severe (Hb <80 g/L [<8 g/dL]) or life-threatening (Hb <65 g/L [<6.5 g/dL]) anaemia
Contributors
Authors
Eric H. Kraut, MD
Professor of Internal Medicine
The Ohio State University
Columbus
OH
Disclosures
EHK declares that he has no competing interests.
Marium Husain, MD, MPH
Assistant Professor of Medicine
The Ohio State University
The Ohio State University James Comprehensive Cancer Center
Columbus
OH
Disclosures
MH declares that she has no competing interests.
Acknowledgements
Dr Eric Kraut and Dr Marium Husain would like to gratefully acknowledge Dr Alice Ma, Dr Damon Houghton, Dr Marco Giovannini, Dr Pasquale Niscola, Dr Karen D. Serrano, Dr Robert D. Woodson, and Dr Kiranveer Kaur, previous contributors to this topic. AM, DH, MG, PN, KDS, RDW, and KK declare that they have no competing interests.
Peer reviewers
Sean R. Lynch, MD
Professor of Clinical Medicine
Eastern Virginia Medical School
Norfolk
VA
Disclosures
SRL declares that he has no competing interests.
Christopher Pechlaner, MD
Associate Professor of Medicine
Innsbruck Medical University
Innsbruck
Austria
Disclosures
CP declares that he has no competing interests.
Robert Chen, MD
Hematology/Oncology Fellow
Department of Medical Oncology
University of Colorado Health Sciences Center
Denver
CO
Disclosures
RC declares that he has no competing interests.
Brady Stein, MD
Associate Professor of Medicine
Northwestern University
Evanston
IL
Disclosures
BS declares that he has no competing interests.
Differentials
- Iron deficiency anaemia
- Iron deficiency anaemia co-existing with ACD
- Anaemia associated with chronic renal disease (erythropoietin deficiency)
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: hematopoietic growth factors
- Chronic kidney disease: assessment and management
More Guidelines
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