[Anemia in chronic disease]

Anaemia of chronic disease is that associated with inflammatory disorders such as prolonged infections, auto-immune diseases and some cancers. The pathogenesis of anaemia of chronic disease is complex and includes a reduced erythropoiesis, slightly shortened red cell survival, and changes in the iron metabolism. New experimental data have shown that cytokines released during the inflammatory process are of crucial importance in this context. In particular interleukin-1 and tumor necrosis factor alpha, released from activated macrophages, have been shown to inhibit erythropoiesis and might initiate changes in iron metabolism. Clinically, anaemia of chronic disease is mild and the underlying disease usually dominates the clinical picture. Most often, the anaemia takes the form of a normocytic, normochromic anaemia with low serum iron although the iron stores are normal or increased. Anaemia of chronic disease should be distinguished from anaemia due to iron deficiency, and at the moment measurement of serum ferritin seems to be the best analysis for this purpose.