Anemia of chronic disease

by Rosemarie Tremblay-LeMay MD FRCPC
November 18, 2023

Anemia of chronic disease (ACD) is a type of anemia that develops when a person has a long-standing illness that causes inflammation. Anemia means that the number of red blood cells (RBCs) or the amount of hemoglobin in the blood is lower than normal. RBCs are responsible for carrying oxygen from your lungs to the rest of your body and carrying carbon dioxide back to the lungs. They hold onto oxygen and carbon dioxide using a specialized protein called hemoglobin.

What causes anemia of chronic disease?

Any condition that causes chronic inflammation can lead to ACD. These conditions include prolonged infections (such as HIV or tuberculosis), kidney disease, and cancer. Most of these conditions cause anemia by lowering the level of a protein called erythropoietin (EPO) in the body. EPO is made by the kidneys and it acts as a signal to tell the bone marrow to make more RBCs. Conditions that cause ACD decrease the amount of EPO made by the kidneys and some can inhibit the response of the bone marrow to EPO, which results in fewer RBCs produced in the bone marrow. Chronic inflammation can also cause anemia by reducing the amount of new iron absorbed from food or how it can be used by the body.

What are the symptoms of anemia of chronic disease?

Symptoms of ACD include fatigue, shortness of breath, weakness, dizziness, and chest pain. However, some people with ACD will experience no symptoms and the condition will be diagnosed only after blood tests are performed for another reason.

How do doctors test for anemia of chronic disease?

A blood test can be used to test for ACD.  When examined under the microscope the RBCs usually have normal size (normocytic), although in some cases they can be smaller than normal (microcytic). The level of ferritin in the blood will be normal or increased, even if the iron stores are decreased. The other iron tests will help determine if there is also iron deficiency, as both ACD and anemia of iron deficiency can happen at the same time.

About this article

This article was written by doctors to help you read and understand your pathology report. Contact us if you have any questions about this article or your pathology report. Read this article for a more general introduction to the parts of a typical pathology report.

Other helpful resources

Atlas of Pathology