Anaemia of Chronic Disease

Anaemia of chronic disease (ACD, also called anaemia of inflammation) develops when chronic inflammation, infection or malignancy redirects iron handling. Inflammatory cytokines drive the liver to produce hepcidin, which blocks iron release from macrophages and reduces gut absorption — paradoxically locking iron away from red-cell production even when total body iron is adequate. Common drivers include rheumatoid arthritis, inflammatory bowel disease, chronic kidney disease, HIV, tuberculosis, and most solid tumours. Distinguishing ACD from iron-deficiency anaemia matters because treatment is opposite: iron supplementation alone doesn't help ACD and may even harm patients with active infection.

• Haemoglobin — typically 9–11 g/dL; severe drops below 8 are unusual without coexisting iron deficiency.
• MCV — usually normal (normocytic) but can be microcytic if iron deficiency coexists.
• Ferritin — paradoxically normal or HIGH because ferritin is an acute-phase reactant (this is the key distinguishing feature from pure iron-deficiency anaemia).
• Transferrin saturation — typically low.
• CRP — usually elevated, confirming the inflammatory state.
• EPO — relatively low for the degree of anaemia (especially in chronic kidney disease).

ACD is usually overshadowed by the symptoms of the underlying chronic disease. The anaemia itself contributes to:

• Fatigue, exercise intolerance
• Pallor
• Dyspnoea on exertion
• Worsening of symptoms of the underlying condition

Unlike severe iron-deficiency anaemia, ACD rarely produces dramatic isolated symptoms — the chronic process dominates the clinical picture.