What Is Anemia of Chronic Disease?

Medically reviewed by Daniel Combs, MD

Anemia of chronic disease (ACD)vis a low red blood cell count (anemia) that occurs due to inflammation from an underlying health condition, such as cancer, kidney disease, or arthritis. Red blood cells are the cells in the blood that contain the protein hemoglobin, which is essential for delivering oxygen to the body. You can develop anemia if your hemoglobin levels are less than 12.0 grams per deciliter (g/dL) for females or less than 13.5 g/dL for males.

ACD is the second most common cause of anemia after iron deficiency. However, it rarely causes severe anemia unless ACD occurs with other types of anemia. The exact symptoms of ACD will depend on the severity of your condition, but most people experience some level of fatigue and shortness of breath. But treating the underlying condition and certain medications can help improve your symptoms.

Symptoms

Symptoms of ACD look similar to other types of anemia. But the symptoms you experience will depend on how severe your condition is and how low your blood cell levels are. In most cases, ACD causes mild to moderate anemia. But if you also have a pre-existing type of anemia (such as iron deficiency anemia) that occurs alongside ACD, your symptoms may become more severe.

With mild anemia, you might not experience any symptoms at all. But if your red blood cell count becomes lower, it becomes more difficult for your body to deliver oxygen to the rest of your body. In turn, this can cause more serious symptoms.

Common symptoms of ACD include:

• Fatigue

• Weakness

• Trouble breathing

• Dizziness

• Rapid heart rate

• Difficulty performing physical activities

• Pale skin

In more severe cases of anemia, chest pain and fainting can occur because your body isn't able to deliver enough oxygen to organs like your heart and brain.

Causes

The spongy substances inside your bones (known as bone marrow) are where precursor cells mature and turn into red or white blood cells. As your body develops and produces red blood cells, it requires iron—an essential component of hemoglobin. Hemoglobin is an important protein in red blood cells that carries oxygen through your blood vessels. Some chronic conditions that cause inflammation can affect how your body stores and uses iron.

With inflammation, the body's immune system releases certain proteins, called cytokines. These proteins can interfere with the process of red blood cell production and prevent iron in your bone marrow from entering into red blood cells. Cytokines also lower the bone marrow's response to erythropoietin—a protein that stimulates red blood cell production.

Conditions That Cause ACD

There are many causes of inflammation in the body, but the following conditions can cause anemia of chronic disease and produce inflammation:

• Chronic infections such as HIV, tuberculosis, and hepatitis C

• Inflammatory and autoimmune conditions like arthritis, lupus, inflammatory bowel disease (such as Crohn's disease and ulcerative colitis), and psoriasis

• Chronic kidney disease

• Cancers, which not only cause inflammation but may also invade the bone marrow and directly interfere with red blood cell production

Diagnosis

If you're experiencing symptoms of anemia or have an underlying diagnosis of one of the conditions that can cause ACD, it's a good idea to see your healthcare provider for testing. Your provider will ask about your symptoms, take your medical history, and perform a physical exam.

After they learn more about your condition, they can order blood tests to help identify the type of anemia you're experiencing and confirm a diagnosis. These tests may include:

• Complete blood count (CBC): Checks your red blood cell and hemoglobin levels

• Blood smear: Takes a sample of your blood and views it under a microscope to look at the shape, size, and color of your blood cells

• Iron test: Looks at how much iron and ferritin (a protein that stores iron) you have in your body to help differentiate ACD from iron deficiency anemia

Sometimes, more invasive testing is required for diagnosis. A bone marrow biopsy is a procedure that occurs when your provider uses a needle to take a sample of tissue from the inner part of the bone. This provides information on your body's ability to make red blood cells and whether you have certain cancers.

Treatments for Anemia of Chronic Disease

The main goals of treatment of ACD are to treat the underlying cause of the problem, restore red blood cell levels, and improve your symptoms. Since ACD is caused by inflammation, it's essential to find and treat the source of your condition.

Your exact treatment plan will depend on the underlying cause of your ACD. For example, if an infection is the root cause of your ACD symptoms, you may need medications like antibiotics or antivirals. Other medical treatments such as corticosteroid medications and immune-modulating therapies can treat inflammatory conditions. An important part of the diagnostic process is to figure out what's causing your ACD so your provider knows how to treat it properly.

Other common treatments for ACD may include:

• Iron supplements

• Injectable medications called erythropoietin-stimulating agents which can help your kidneys if they are not making enough erythropoietin

• Blood transfusion to improve red blood cell counts if your levels drop to less than 7 grams per deciliter (g/dL)

How to Prevent ACD

It's not always possible to prevent ACD. But if you have an underlying condition, it's important to see your provider regularly for checkups. It's also important to make an appointment with your provider if you experience any symptoms of ACD.

However, you can follow these tips to help lower your risk of ACD and other chronic health conditions:

• Keeping your blood pressure and blood sugar levels in check

• Avoiding IV drug use which can increase your risk of infections

• Getting care for your underlying health conditions and following your treatment plan properly

If your healthcare provider has diagnosed you with any kind of anemia, it's important to pay attention to your symptoms and follow your treatment plan. Eating a diet rich in iron or taking iron supplements can also help prevent complications from anemia.

Complications

If your condition is left untreated or occurs alongside other anemias, ACD can cause complications like angina (chest pain due to low blood flow to the heart). ACD can also worsen underlying health conditions, like heart failure or coronary artery disease.

ACD during pregnancy can also cause certain problems. During pregnancy, the developing fetus requires its own hemoglobin. It's common for pregnant people to have lower blood counts due to the expansion of blood volume that happens during pregnancy, but significant anemia can lead to premature birth and growth problems for the fetus.

A Quick Review

ACD is a condition that causes low levels of red blood cells due to an underlying health condition that causes inflammation. These health conditions may include infections, cancer, arthritis, kidney disease, and lupus, among others. With ACD, it's common to experience symptoms like fatigue and shortness of breath. These symptoms are usually mild unless you have another type of anemia that occurs alongside ACD. But medications and other therapies can help restore blood counts and improve symptoms.

Frequently Asked Questions

When is anemia life-threatening?

Anemia can be life-threatening when blood counts are severely low, or when it occurs rapidly, such as in severe bleeding. Severely low blood counts impair the oxygen delivery to the body's tissues, including the brain and heart, which can cause fainting, abnormal heart rhythms, and death.

What hemoglobin level requires blood transfusion?

Blood transfusions may be necessary if your hemoglobin levels drop below 7 grams per deciliter. However, you may need a blood transfusion at higher blood counts if anemia is causing more severe symptoms or worsening symptoms of underlying conditions like heart failure.

Can anemia cause heart disease?

Anemia and heart conditions are related. Anemia and heart failure commonly occur together, each making the other condition worse. Longstanding and untreated anemia can cause a form of heart failure. Significant anemia can also worsen symptoms and outcomes in coronary artery disease. People with heart conditions should talk with their healthcare provider about treating anemia.

For more Health.com news, make sure to sign up for our newsletter!

Read the original article on Health.com.