Anemia of chronic disease

Anemia of chronic disease
Classification and external resources
ICD-9-CM	285.29
MedlinePlus	000565
eMedicine	emerg/734
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Anemia of chronic disease, or anemia of chronic inflammation, is a form of anemia seen in chronic infection, chronic immune activation, and malignancy. These conditions all produce massive elevation of Interleukin-6, which stimulates hepcidin production and release from the liver, which in turn reduces the iron carrier protein ferroportin so that access of iron to the circulation is reduced. Other mechanisms may also play a role, such as reduced erythropoiesis.

Anemia of chronic inflammation is the preferred term since not all chronic diseases are associated with this form of anemia.

Anemia is considered when RBCs count :

Or Hemoglobin ( Hb ) content :

In response to inflammatory cytokines, increasingly IL-6, the liver produces increased amounts of hepcidin. Hepcidin in turn causes increased internalisation of ferroportin molecules on cell membranes which prevents release from iron stores. Inflammatory cytokines also appear to affect other important elements of iron metabolism, including decreasing ferroportin expression, and probably directly blunting erythropoiesis by decreasing the ability of the bone marrow to respond to erythropoietin.

Before the recent discovery of hepcidin and its function in iron metabolism, anemia of chronic disease was seen as the result of a complex web of inflammatory changes. Over the last few years, however, many investigators have come to feel that hepcidin is the central actor in producing anemia of chronic inflammation. Hepcidin offers an attractive Occam's Razor (parsimonious) explanation for the condition, and more recent descriptions of human iron metabolism and hepcidin function reflect this view.

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