Anemia of chronic disease, the anemia that is the second most prevalent after anemia caused by iron deficiency, occurs in patients with acute or chronic immune activation. The condition has thus been termed “anemia of inflammation” but in many cases no obvious inflammatory cause is apparent. It is imperative to rule out iron deficiency co-existisng with chronic disease but in the presence of chronic disease, iron studies are unreliable and a bone marrow or a prolonged therapeutic trial are required. Hypothyroidism also can cause anemia but the mechanism appears to be hemodilution.
Erytropoietin, and presumably darbepoietin is best studied in the anemia of chronic disease due to rheumatoid arthritis, where randomized studies confirm its effectiveness.
Peeters HR, JongenLavrencic M, Vreugdenhil G, et al. Effect of recombinant human erythropoietin on anaemia and disease activity in patients with rheumatoid arthritis and anaemia of chronic disease: a randomised placebo controlled double blind 52 week clinical trial. Ann Rheum Dis 2005;55:739-44
Peeters HRM, Jongen-Lavrencic M, Vreugdenhil G, Swaak AJG. Effect of recombinant human erythropoietin on anemia and disease activity in patients with rheumatoid arthritis and anemia of chronic disease: a randomised placebo-controlled double blind 52-weeks clinical trial. Ann Rheum Dis 1996;55:739-44
Kaltwasser JP, Kessler U, Gottschalk R, et al. Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. J Rheumatol 2001;28:2340-436
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Gangat N, Wolanskyj AP. Anemia of chronic disease. Semin Hematol 2013; 50:232.
Macciò A, Madeddu C, Gramignano G, et al. The role of inflammation, iron, and nutritional status in cancer-related anemia: results of a large, prospective, observational study. Haematologica 2015; 100:124.