Anaemia of chronic disease

Anaemia of chronic disease (ACD) is a term used to describe a type of anaemia seen in a wide range of chronic inflammatory, infective and malignant diseases (Table 18.1). The anaemia often becomes apparent during the first few months of illness and then remains fairly constant (Fig 18.1). It is rarely severe (haemoglobin ≥90 g/L; packed cell volume (PCV) ≥0.30) but there is some correlation with the intensity of the underlying illness. For instance, in infection the anaemia is often more marked where there is a persistent fever and in malignancy where there is widespread dissemination. Patients may suffer no symptoms from their anaemia or have only slight fatigue. The importance of this type of anaemia arises not from its severity but from its ubiquity. It is widely misunderstood (for such a common disorder) and ill patients are frequently subjected to excessive haematological investigation and unnecessary treatment with haematinics. The term ACD should not be used to describe other causes of anaemia such as haemolysis or bleeding which may also complicate chronic disorders. It has been argued that the designation ACD is inappropriate but other suggested terms (e.g. anaemia of inflammation) appear even less satisfactory. The anaemia of chronic renal failure is variously referred to as ACD although it has its own specific features (see p. 96).

Table 18.1

Common causes of the anaemia of chronic disease