Anaemia of chronic disease
Mild microcytic or normocytic anaemia can be caused by ACD
Causes of ACD:
Malignancy
Rheumatological diseases - rheumatoid arthritis, polymyalgia
Chronic infection
Inflammatory cytokines cause reduced iron utilisation and impaired RBC
production
Severity of anaemia reflects disease activity
Anaemia only improves if the underlying disease is successfully treated or
controlled
Renal anaemia
CKD could be a possible cause of anaemia if GFR <60
CKD is a likely cause if GFR <30 (or <45 in diabetics)
Should not be assessed until iron deficiency is corrected
Can measure serum erythropoietin in clinic (remember EPO is produced by
the kidneys)
Haemolytic anaemia
This is the abnormal breakdown of red blood cells (RBCs), either in the blood
vessels (intravascular hemolysis) or elsewhere in the human body
(extravascular, but usually in the spleen)
Normal RBCs survive for around 120 days in circulation
The bone marrow can compensate for mild reductions but in severe cases the
survival may be down to just a few days and patients will be pale and
jaundiced
Mild haemolysis is seen in thalassaemia and sickle cell disease
Thalassaemia
Normal haemoglobin (HbA) is α2β2
Mild microcytic or normocytic anaemia can be caused by ACD
Causes of ACD:
Malignancy
Rheumatological diseases - rheumatoid arthritis, polymyalgia
Chronic infection
Inflammatory cytokines cause reduced iron utilisation and impaired RBC
production
Severity of anaemia reflects disease activity
Anaemia only improves if the underlying disease is successfully treated or
controlled
Renal anaemia
CKD could be a possible cause of anaemia if GFR <60
CKD is a likely cause if GFR <30 (or <45 in diabetics)
Should not be assessed until iron deficiency is corrected
Can measure serum erythropoietin in clinic (remember EPO is produced by
the kidneys)
Haemolytic anaemia
This is the abnormal breakdown of red blood cells (RBCs), either in the blood
vessels (intravascular hemolysis) or elsewhere in the human body
(extravascular, but usually in the spleen)
Normal RBCs survive for around 120 days in circulation
The bone marrow can compensate for mild reductions but in severe cases the
survival may be down to just a few days and patients will be pale and
jaundiced
Mild haemolysis is seen in thalassaemia and sickle cell disease
Thalassaemia
Normal haemoglobin (HbA) is α2β2
