Clinical approach to the patient with anemia of chronic disease

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Dr. Robert Schilling has proposed that the “anemia of chronic disease” is better termed the “anemia of chronic inflammation,” for it is a hypoproliferative anemia syndrome that occurs as the result of the chronic inflammatory response to an underlying disorder such as infection, malignancy, immune-mediated disease, or trauma (1). This is the most common form of anemia in hospitalized adults in nontropical countries. The characteristic clinical findings are (1) an underlying chronic inflammatory process, (2) mild or moderate anemia, (3) hypoferremia, and (4) normal or increased iron stores in the bone marrow. The diagnosis of the anemia of chronic disease is to a certain extent an exercise in exclusion of other forms of anemia. Therefore, in evaluating a patient with the possible diagnosis of the anemia of chronic disease, it is essential to perform the history, physical examination, and laboratory tests necessary to exclude other forms of anemia such as immune hemolysis, nutritional and hormonal deficiencies, hemoglobinopathies, red cell enzyme and structural defects, or bone marrow failure. Treatment is usually directed at the underlying condition rather than the anemia. It is important to consider and make the diagnosis of anemia of inflammation, for unnecessary therapy with iron salts during infection or inflammation is potentially toxic.

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