Anemia of chronic disease
Summary
Definition
History and exam
Key diagnostic 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 anemia
- 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 tests
1st tests to order
- 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
Tests to avoid
- flow cytometry
Tests to consider
- 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
Treatment algorithm
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
Contributors
Authors
Marina Beltrami Moreira, MD
Assistant Professor
The Ohio State University Wexner Medical Center
The Ohio State University College of Medicine
Columbus
OH
Disclosures
MBM declares that she has no competing interests.
Acknowledgements
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 por pares
Sean R. Lynch, MD
Professor of Clinical Medicine
Eastern Virginia Medical School
Norfolk
VA
Divulgaciones
SRL declares that he has no competing interests.
Christopher Pechlaner, MD
Associate Professor of Medicine
Innsbruck Medical University
Innsbruck
Austria
Divulgaciones
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
Divulgaciones
RC declares that he has no competing interests.
Brady Stein, MD
Associate Professor of Medicine
Northwestern University
Evanston
IL
Divulgaciones
BS declares that he has no competing interests.
Agradecimiento de los revisores por pares
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Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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 Resumen
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
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Iron deficiency anemia
- Iron deficiency anemia coexisting with ACD
- Anemia associated with chronic renal disease (erythropoietin deficiency)
Más DiferencialesGuías de práctica clínica
- NCCN clinical practice guidelines in oncology: hematopoietic growth factors
- Management of cancer-associated anemia with erythropoiesis-stimulating agents: ASCO/ASH clinical practice guideline update
Más Guías de práctica clínica
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