Anaemia of chronic disease

Last reviewed: 28 Aug 2022
Last updated: 16 Mar 2022

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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • autoimmune disorders
  • malignancy
  • acute or chronic infection
  • critical illness, major trauma, or major surgery with delayed recovery
  • chronic disease
More risk factors

Diagnostic investigations

1st investigations to order

  • Hb
  • WBC and differential
  • platelet count
  • MCV
  • MCHC
  • peripheral blood smear
  • serum ferritin
  • serum iron
  • total iron binding capacity
  • transferrin saturation
  • absolute reticulocyte count
  • serum creatinine
More 1st investigations to order

Investigations to consider

  • 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
More investigations to consider

Treatment algorithm

ACUTE

persistent 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

Haematology/Oncology Fellow

Haematology/Oncology

The Ohio State University James Comprehensive Cancer Center

Columbus

OH

Disclosures

MH declares that she has no competing interests.

Kiranveer Kaur, MD

Oncology Hospitalist

Assistant Professor of Medicine

Internal Medicine

Division of Medical Oncology

The Ohio State University Wexner Medical Center

Columbus

OH

Disclosures

KK declares that she has no competing interests.

Acknowledgements

Dr Eric Kraut, Dr Marium Husain, and Dr Kiranveer Kaur would like to gratefully acknowledge Dr Alice Ma, Dr Damon Houghton, Dr Marco Giovannini, Dr Pasquale Niscola, Dr Karen D. Serrano, and Dr Robert D. Woodson, previous contributors to this topic. AM, DH, MG, PN, KDS, and RDW 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.

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