Anemia of Chronic Disease: Causes, Diagnosis, and Treatment
Anemia of chronic disease is traditionally known as hypoproliferative anemia, anemia of inflammation, or anemia of chronic inflammation. Actually, the anemia has no apparent cause, but it occurs in association with certain disorders like inflammation, infections, or neoplastic disorders. Normally, the anemia related to chronic disease will resolve as the underlying disorder resolves. In fact, this is the second most common type of anemia in the world.
Anemia of Chronic Disease ICD 10 Version
The 10th Revision of International Statistical Classification of Disease (ICD) and Related Health Problems (ICD 10) classifies anemia of chronic disease under the Third Chapter, namely Diseases of the Blood and Blood-Forming Organs and Certain Disorders that Involve the Immune Mechanism. It belongs to the sub-category “Aplastic and Other Anemia.” This sub-category also includes chronic diseases of the kidney, such as acute renal failures, chronic renal failure, and renal insufficiency.
This type of anemia is characterized by low levels of red blood cells or hemoglobin in circulation. As widely known, hemoglobin serves to carry oxygen. Amount of serum iron transferrin is low to normal. Meanwhile, level of ferritin can be normal or increased. In mild cases, chronic disease-associated anemia shows such symptoms as fatigue, pale skin (pallor), dizziness, shortness of breath, irritability, fast/irregular heartbeats, or chest pain.
Anemia of Chronic Disease: Causes
Unfortunately, the underlying mechanisms that lead to anemia is complex and multi-factors. The exact cause of anemia of chronic disease varies with individuals. Besides lack of circulating red blood cells or hemoglobin, the anemia may be the result of the following conditions:
- Impaired production of red blood cells or impaired erythropoietin. This hormone works to promote the production of red blood cells.
- In cancer patients, the cancer cells may secrete a substance that impair or even damage the red blood cells. Infection diseases or cancer cells may damage the bone marrow, where blood cells are formed.
- In the patients of chronic kidney disease, anemia may be the result of erythropoietin deficiency, which happens due to damaged kidney cells.
- Lack of functional iron to produce hemoglobin may be related to excess hepdicin. The hormone traps too much iron within the cells. As result, there is no enough iron for hemoglobin production.
Anemia of Chronic Disease TIBC Test
The doctor needs to make a diagnosis after doing a series of test and clinical evaluation. The tests may include measurements of hemoglobin levels, ferritin levels, total iron binding capacity (TIBC), transferrin saturation, or levels of iron in the serum. Total iron binding capacity (TIBC) is a blood test to see whether your blood has too much or too little iron. The iron is carried throughout the body by a protein called transferrin. TIBC test also evaluates whether transferrin works optimally.
The doctor usually suggests this test when abnormal iron level is suspected. Iron deficiency may be caused by certain conditions like blood loss and chronic infections. It is characterized by the feeling of tiredness, skin pallor, swollen tongue, or feeling cold. On the other hand, too high iron level can be the results of iron poisoning, liver damage, or frequent blood transfusion.
Anemia of Chronic Disease Treatment
Treatment of Underlying Disease
Treatment of anemia of chronic disease aimed at treating the underlying disease. If this is successful, the anemia will resolve on its own without direct treatment. However, treating the underlying disease may be difficult if it is chronic. Therefore, the doctors usually prescribe treatment to correct the imbalance in the body. They include iron supplementation. However, this is not recommended if the patient has normal or high ferritin levels.
Anemia of Chronic Kidney Disease Treatment Guidelines
When the anemia is associated with chronic kidney disease, the treatment options may vary. They include the following:
- Simple observation is enough in patients with non-severe anemia. This is also the choice if treatment does not improve Hb level and if the underlying disease cannot be treated.
- Red blood cell transfusion is indicated if the anemia may affect the patients’ quality of life. It is also indicated in severe or life-threatening anemia. However, the doctors need to weigh the benefits against the risks carefully.
- Iron supplements and recombinant erythropoietin (EPO) are combined to make sure that the patient’s body responds to EPO. However, the treatment must be done under careful monitoring of Hb response. Recombinant erythropoietin (EPO) may be related to some adverse effects, such as myocardial infarction and even death.
As the name suggests, anemia of chronic disease is associated with various chronic diseases, such as cancer, infections, autoimmune diseases, and inflammatory diseases, like rheumatoid arthritis or lupus. Treating these diseases will automatically treat the anemia.
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