hematology and oncology
Anemia of Chronic Disease
Diagnosis of Anemia of Chronic Disease
Symptoms and signs of the underlying disorder Complete blood count (CBC) and serum iron, ferritin, transferrin (or total iron binding capacity), and reticulocyte count Clinical findings in the anemia of chronic disease are usually those of the underlying disorder (infection, inflammation, cancer). The anemia of chronic disease should be suspected in patients with microcytic or normocytic anemia who also have chronic illness, infection, inflammation, or cancer. If anemia of chronic disease is suspected, serum iron, transferrin, reticulocyte count and serum ferritin are measured. Hb usually is>8 g/dL (> 80 g/L) unless an additional mechanism contributes to anemia, such as concomitant iron deficiency (see table) or iatrogenic phlebotomy. 100 ng/mL (< 224.7 pmol/L) in a patient with inflammation (< 200 ng/mL [< 449.4 pmol/L] in patients with Chronic Kidney Disease ) suggests that iron deficiency may be superimposed on anemia of chronic disease, because serum ferritin is usually elevated as an acute-phase reactant. If the diagnosis is not clear following standard iron studies, soluble transferrin receptor (sTFR) and sTFR-ferritin index (elevated in iron deficiency) and/or reticulocyte hemoglobin content (ret-He), which is low in iron deficiency, may help identify concomitant iron deficiency and anemia of chronic disease, although these test results may also be subject to confounding effects of inflammation or pre-analytical variables. In patients with possible inflammation and in whom other causes of anemia have been excluded, erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) may be obtained because these test results are nonspecific markers of inflammation. 