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Anemia of Chronic Disease

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In anemia of chronic disease, some chronic disorder slows the production of red blood cells, the result of production of proteins called cytokines that interfere with the production of red blood cells.

Chronic disease often leads to anemia, especially in older adults. Conditions such as infections, inflammation, and cancer particularly suppress production of red blood cells in the bone marrow. Since the suppression is usually not severe, anemia develops slowly and is evident only after time. Problems with how the body uses iron contribute to anemia of chronic disease. Because the bone marrow is unable to use stored iron to create new red blood cells, this type of anemia is often called iron-reutilization anemia.

Because this type of anemia develops slowly and is generally mild, it usually produces few or no symptoms. When symptoms do occur, they usually result from the disease causing the anemia rather than from the anemia itself. There are no specific laboratory tests, so the diagnosis is typically made by excluding other causes.

Because no specific treatment exists for this type of anemia, doctors treat the disorder causing it. Taking additional iron or vitamins does not help. On the rare occasion that the anemia becomes severe, transfusions may help. Alternatively, erythropoietin Some Trade Names
EPOGEN
PROCRIT
or darbepoietin, drugs that stimulate the bone marrow to produce red blood cells, may be given.

Aplastic Anemia: When the Bone Marrow Shuts Down

When the bone marrow cells that develop into mature blood cells and platelets (stem cells) are damaged or suppressed, the bone marrow can shut down. This bone marrow failure is called aplastic anemia. A common cause of aplastic anemia is an autoimmune disorder, in which the immune system suppresses bone marrow stem cells. Other causes include infection with parvovirus, radiation exposure, toxins (such as benzene), chemotherapy drugs, and other drugs (such as chloramphenicol Some Trade Names
CHLOROMYCETIN
).

The bone marrow failure leads to too few red blood cells (anemia), too few white blood cells (leukopenia), and too few platelets (thrombocytopenia). The anemia causes fatigue, weakness, and paleness. The leukopenia causes increased susceptibility to infection. The thrombocytopenia causes easy bruising and bleeding. In some people, only red blood cell production is affected (resulting in a condition called pure red blood cell aphasia). When parvovirus infection is the cause, only red blood cell production is likely to be affected. Aplastic anemia is diagnosed when microscopic examination of a sample of bone marrow (bone marrow biopsy) reveals a sharp decrease in the number of stem cells and in the maturation of blood cells.

People with severe aplastic anemia quickly die unless immediately treated. Transfusions of red blood cells, platelets, and substances called growth factors may temporarily increase the numbers of red blood cells, white blood cells, and platelets. Stem cell or bone marrow transplantation can cure aplastic anemia in younger and middle-aged people. Older adults and people without a suitable bone marrow donor often respond to treatment with corticosteroids and drugs that suppress the immune system.

Last full review/revision June 2008 by Alan E. Lichtin, MD

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