ANEMIA OF CHRONIC DISEASE

Anemia of chronic disease is anemia, or a decreased hemoglobin level, that accompanies a chronic disease. Any type of chronic disease of more than 1 or 2 months duration can cause anemia. Inflammatory, infectious, or malignant conditions can cause anemia. Anemia of chronic disease is associated most frequently with rheumatoid arthritis, tuberculosis, acquired immune deficiency syndrome (AIDS), endocarditis, lung abscess, chronic osteomyelitis, malignant tumors, and lymphoma.

The mechanism of anemia of chronic disease is not fully understood. The immune disturbance of chronic inflammation causes decreased production of a growth factor for red blood cells. An impaired incorporation of iron into the red blood cells occurs. The life span of the red blood cells shortens. Anemia of chronic disease is common; the only type of anemia that is more common is iron deficiency anemia.

Microscopic examination of the blood provides the basis for the diagnosis. Special blood tests used to measure the content of iron (ferritin, serum iron, and iron-binding capacity) help confirm the diagnosis. A bone marrow examination frequently is necessary to rule out deficiency in iron and other conditions that lead to anemia.

Successful management of underlying disease results in marked improvement in the anemia. Special treatments can improve the anemia and its symptoms.

Anemia of chronic disease is usually moderate and rarely causes symptoms. If left unrecognized, the anemia worsens. This manifests as easy fatigability and decreased tolerance of exercise. Patients with underlying cardiovascular and pulmonary diseases are at particular risk. Combinations of these diseases with anemia deserve special attention. Severe anemia can cause chest pain, shortness of breath, and palpitations.

The main treatment is control and correction of the underlying disease. This is likely to improve the anemia and its signs. Patients with symptomatic anemia related to diseases that cannot be managed effectively, can benefit from treatment with erythropoietin (e.g., Epogen, Procrit). This is a growth factor for red blood cells that is produced by means of special technology. It stimulates the red blood cells to grow and develop normally. An increase in hemoglobin can be observed during 3 to 4 weeks of treatment. Patients who respond to erythropoietin continue long-term therapy. Blood transfusions may be necessary for patients with severe anemia.

Erythropoietin treatment is prescribed and monitored by a physician. Patients receive erythropoietin as an injection under the skin three times a week. Follow-up blood tests are performed to determine whether there is a response. Continuous use of erythropoietin may be necessary. Erythropoietin therapy is usually well tolerated. Erythropoietin can cause elevations in blood pressure, but this is rare. Patients with preexisting seizure disorders should be monitored for seizures.

• Follow treatment recommendations for the underlying condition.
• Discuss with a physician any new medications and their effects on anemia.
• Eat a well-balanced diet rich in iron and folic acid to maintain production of red blood cells.
• Participate in nonstrenuous exercise if you have mild or moderate anemia.
• Use Medic Alert identification if you have severe anemia.

• Do not take iron-containing vitamins. Iron overload can develop.
• Avoid strenuous exercise.

• If you experience chest pain, palpitations, dizziness, or shortness of breath. These are symptoms of severe anemia.

_______________________________________________________________________________________________________________________________
Copyright © 2000 Mosby, Inc.
All rights reserved.  No part of this publication may be reproduced or transmitted in any form or for any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher.
_______________________________________________________________________________________________
For Comments/Suggestion send email to: webmaster@apma-nc.com