Anemia of chronic disease

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Última revisão: 20 Jul 2025

Última atualização: 14 Aug 2025

Anemia of chronic disease (ACD) is characterized by anemia and evidence of immune system activation.

Anemia is mainly due to decreased red blood cell production; may be aggravated by shortened red blood cell survival.

Commonly found in acute and chronic infections; autoimmune disorders; chronic diseases; malignancy; after major trauma, surgery, or critical illness; and among older adults.

Physical examination findings are those of the underlying disorder.

Therapeutic approach is primarily treatment of the underlying disorder, although treatment of the anemia itself is sometimes appropriate.

Definição

ACD is a common syndrome in which the anemia is due to an inflammation-mediated reduction in red blood cell (RBC) production and sometimes in RBC survival.[1][2]

Laboratory studies, which collectively identify the syndrome, typically show normocytic normochromic or microcytic hypochromic anemia, relatively low absolute reticulocyte count, low serum iron, low total iron-binding capacity, low to normal percent transferrin saturation, and elevated ferritin.

História e exame físico

Principais fatores diagnósticos

systemic symptoms of underlying condition
absent history of bleeding
physical finding suggesting infection
physical finding suggesting neoplasm
physical finding suggesting autoimmune disorder

Detalhes completos

Outros fatores diagnósticos

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 anemia
absent history of poor nutrition
decreased exercise tolerance
shortness of breath with exercise
fatigue
pallor

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Hb
WBC and differential
platelet count
mean corpuscular volume (MCV)
mean corpuscular hemoglobin concentration (MCHC)
peripheral blood smear
serum ferritin
serum iron
total iron-binding capacity
transferrin saturation
absolute reticulocyte count
serum creatinine

Detalhes completos

Tests to avoid

flow cytometry

Detalhes completos

Investigações a serem consideradas

C-reactive protein (CRP)
erythrocyte sedimentation rate
serum B12
serum folate
thyroid function tests
LFTs
indirect and direct bilirubin
LDH
erythropoietin
hemoglobin electrophoresis
bone marrow biopsy
soluble transferrin receptor
ratio of soluble transferrin receptor to log ferritin

Detalhes completos

Algoritmo de tratamento

AGUDA

mild to moderate anemia (hemoglobin [Hb] 8 to 11 g/dL)

severe (Hb <8 g/dL) or life-threatening (Hb <6.5 g/dL) anemia

Colaboradores

Autores

Marina Beltrami Moreira, MD

Assistant Professor

The Ohio State University Wexner Medical Center

The Ohio State University College of Medicine

Columbus

Declarações

MBM declares that she has no competing interests.

Agradecimentos

Dr Marina Beltrami Moreira would like to gratefully acknowledge Dr Eric Kraut, Dr Marium Husain, 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. EK, MH, AM, DH, MG, PN, KDS, RDW, and KK declare that they have no competing interests.

Revisores

Sean R. Lynch, MD

Professor of Clinical Medicine

Eastern Virginia Medical School

Norfolk

Declarações

SRL declares that he has no competing interests.

Christopher Pechlaner, MD

Associate Professor of Medicine

Innsbruck Medical University

Innsbruck

Austria

Declarações

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

Declarações

RC declares that he has no competing interests.

Brady Stein, MD

Associate Professor of Medicine

Northwestern University

Evanston

Declarações

BS declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

KDIGO Anemia Work Group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int Suppl. 2012;2(4):279-335.Texto completo

Bohlius J, Bohlke K, Castelli R, et al. Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update. J Clin Oncol. 2019 Apr 10;37(15):1336-51.Texto completo Resumo

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hematopoietic growth factors [internet publication].Texto completo

Aapro M, Beguin Y, Bokemeyer C, et al. Management of anaemia and iron deficiency in patients with cancer: ESMO clinical practice guidelines. Ann Oncol. 2018 Oct 1;29(suppl 4):iv271.Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Iron deficiency anemia
- Iron deficiency anemia coexisting with ACD
- Anemia associated with chronic renal disease (erythropoietin deficiency)
Mais Diagnósticos diferenciais
Diretrizes
- NCCN clinical practice guidelines in oncology: hematopoietic growth factors
- Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update
Mais Diretrizes
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Anemia of chronic disease

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Tests to avoid

Investigações a serem consideradas

Algoritmo de tratamento

mild to moderate anemia (hemoglobin [Hb] 8 to 11 g/dL)

severe (Hb <8 g/dL) or life-threatening (Hb <6.5 g/dL) anemia

Colaboradores

Autores

Marina Beltrami Moreira, MD

Declarações

Agradecimentos

Revisores

Sean R. Lynch, MD

Declarações

Christopher Pechlaner, MD

Declarações

Robert Chen, MD

Declarações

Brady Stein, MD

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice