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Anemia of chronic disease: illness or adaptive mechanism
Insights
Anemia of chronic disease (ACD) involves abnormal iron metabolism due to inflammatory cytokines, impacting red blood cell production. Treatment focuses on the underlying condition, with newer therapies like hepcidin antagonists under investigation.
Area of Science:
- Hematology
- Immunology
- Pathophysiology
Background:
- Anemia of chronic disease (ACD) is a common anemia, second only to iron deficiency anemia.
- It is frequently associated with chronic infections, inflammatory conditions, and neoplastic diseases.
Purpose of the Study:
- To summarize the pathophysiology and current therapeutic strategies for anemia of chronic disease.
- To highlight emerging therapeutic targets and agents for ACD management.
Main Methods:
- Review of the literature on the pathogenesis of ACD.
- Analysis of the role of cytokines and iron metabolism in ACD.
- Evaluation of current and novel therapeutic approaches.
Main Results:
- ACD is characterized by impaired iron availability for erythropoiesis due to cytokine-induced iron trapping.
- Disordered erythropoietin secretion and reduced red blood cell lifespan contribute to ACD.
- Standard therapy includes treating the underlying disease and red blood cell transfusions.
Conclusions:
- Effective management of ACD relies on addressing the primary condition and supporting erythropoiesis.
- Erythropoiesis-stimulating agents are used for severe cases impacting quality of life and survival.
- Novel therapies, including chelating agents and hepcidin antagonists, show promise for specific ACD scenarios.
Abstract:
The anemia of chronic disease (ACD) is the most prevalent anemia after iron deficiency anemia. It is associated with infectious, inflammatory and neoplastic disease. ACD is a medical condition caused by the release of cytokines which mediate inflammatory and immune response (tumor necrosis factor, interleukins 1 and 6, and interferon). Abnormal iron metabolism with iron trapping in reticuloendothelial cells is primarily the cause of this condition, making iron unavailable for erythropoiesis although iron tissue reserves are elevated. Disorder in erythropoietin secretion and shortening of red cell life span also play a role in the pathogenesis of ACD. The main therapy is treatment of the underlying disorder and red cell transfusions in severe anemia. In more severe (protracted) anemias that lead to impaired quality of life and have an impact on the mortality and survival rate, erythropoiesis stimulating agents are used. Recently, new possibilities are being evaluated in terms of therapy for ACD in defined conditions, such as chelating agents, as well as hepcidin antagonist and other erythropoiesis stimulating agents.
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