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Anemia de doença crônica

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 22 Jul 2025
Last updated: 11 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • sintomas sistêmicos de doença subjacente
  • ausência de história de sangramento
  • achado físico que sugere infecção
  • achado físico que sugere neoplasia
  • achado físico que sugere distúrbio autoimune
Full details

Other diagnostic factors

  • ausência de história de ingestão elevada de bebidas alcoólicas
  • ausência de história de exposição a produtos químicos e radiação
  • ausência de história de medicamentos conhecidos por estarem associados ao risco de anemia
  • ausência de história de desnutrição
  • tolerância reduzida ao exercício
  • dispneia no exercício
  • fadiga
  • palidez
Full details

Risk factors

  • doenças autoimunes
  • neoplasia maligna
  • infecção aguda ou crônica
  • enfermidade crítica, trauma maior ou cirurgia de grande porte com recuperação demorada
  • doenças crônicas
Full details

Diagnostic tests

1st tests to order

  • hemoglobina (Hb)
  • leucócitos e diferencial
  • contagem plaquetária
  • volume corpuscular médio (VCM)
  • concentração de hemoglobina corpuscular média (CHCM)
  • esfregaço de sangue periférico
  • ferritina sérica
  • ferro sérico
  • capacidade total de ligação do ferro
  • saturação de transferrina
  • contagem absoluta de reticulócitos
  • creatinina sérica
Full details

Tests to consider

  • proteína C-reativa
  • velocidade de hemossedimentação
  • vitamina B12 sérica
  • folato sérico
  • testes da função tireoidiana
  • TFHs
  • bilirrubina direta e indireta
  • lactato desidrogenase (LDH)
  • eritropoetina
  • eletroforese da hemoglobina
  • biópsia da medula óssea
  • receptor solúvel de transferrina
  • concentração do receptor solúvel de transferrina para se ligar à ferritina
Full details

Treatment algorithm

ACUTE

anemia leve a moderada (hemoglobina [Hb] 80 a 110 g/L [8 a 11 g/dL])

anemia grave (Hb <80 g/L [<8 g/dL]) ou anemia com risco de vida (Hb <65 g/L [6.5 g/dL])

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 has a pending research grant from the Pfizer-NCCN grant programme.

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.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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

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.Full text  Abstract

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

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.

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • Differentials

    • Anemia ferropriva
    • Anemia ferropriva coexistente com ADC
    • Anemia associada à doença renal crônica (deficiência de eritropoetina)
    More Differentials

  • Diretrizes

    • NCCN clinical practice guidelines in oncology: hematopoietic growth factors
    • Chronic kidney disease: assessment and management
    More Guidelines
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