Anaemia of chronic disease

Last updated Nov. 2, 2025, 10:57 p.m. by ivo

Tags: Anaemia

The haemoglobin reference range will vary depending on the age, gender and pregnancy status of the patient, as well as the laboratory performing the test. In general, the haemoglobin is considered to be low when it is < 130 g/L in males and <115 g/L in females.

Anaemia of chronic disease occurs when, in the presence of chronic disease/inflammation, the reticuloendothelial system sequesters iron stores and fails to release it for erythropoiesis in the bone marrow. Any condition associated with an inflammatory response can cause anaemia of chronic disease and it can be seen in within two weeks of the onset of inflammation.

Diagnosis

Anaemia of chronic disease may be normocytic or microcytic. Iron studies may show decreased serum iron, serum transferrin, total iron binding capacity (TIBC) and transferrin saturation, with a normal ferritin and normal soluble transferrin receptor levels.

Causes

• Acute and chronic infections
• Chronic kidney disease
• Congestive cardiac failure, COPD and chronic lung conditions
• Autoimmune conditions including rheumatoid arthritis and systemic lupus erythematosus
• Malignancy
• Obesity

Management

• Exclude other causes of anaemia - reticulocyte count, haemolytic screen, serum protein electrophoresis and free light chains, B12 and folate.
• The mainstay of management of anaemia of chronic disease is in managing the underlying medical condition

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When To Refer

Symptoms

• Unexplained fevers > 38° C
• Drenching night sweats
• Unintentional weight loss

Physical examination

• Hepatosplenomegaly
• Lymphadenopathy

Laboratory

• Haemoglobin < 100g/L
• Neutropenia < 1 x 10⁹/L
• Thrombocytopenia < 100 x 10⁹/L
• Immature cells on peripheral film
• Dysplastic features present on the blood film