What Is Anemia of Chronic Disease?
Medically reviewed by Daniel Combs, MD
Anemia of chronic disease (ACD)vis a low red blood cell count (anemia) that occurs due to inflammation from an underlying health condition, such as cancer, kidney disease, or arthritis. Red blood cells are the cells in the blood that contain the protein hemoglobin, which is essential for delivering oxygen to the body. You can develop anemia if your hemoglobin levels are less than 12.0 grams per deciliter (g/dL) for females or less than 13.5 g/dL for males.
ACD is the second most common cause of anemia after iron deficiency. However, it rarely causes severe anemia unless ACD occurs with other types of anemia. The exact symptoms of ACD will depend on the severity of your condition, but most people experience some level of fatigue and shortness of breath. But treating the underlying condition and certain medications can help improve your symptoms.
Symptoms
Symptoms of ACD look similar to other types of anemia. But the symptoms you experience will depend on how severe your condition is and how low your blood cell levels are. In most cases, ACD causes mild to moderate anemia. But if you also have a pre-existing type of anemia (such as iron deficiency anemia) that occurs alongside ACD, your symptoms may become more severe.
With mild anemia, you might not experience any symptoms at all. But if your red blood cell count becomes lower, it becomes more difficult for your body to deliver oxygen to the rest of your body. In turn, this can cause more serious symptoms.
Common symptoms of ACD include:
In more severe cases of anemia, chest pain and fainting can occur because your body isn't able to deliver enough oxygen to organs like your heart and brain.
Causes
The spongy substances inside your bones (known as bone marrow) are where precursor cells mature and turn into red or white blood cells. As your body develops and produces red blood cells, it requires iron—an essential component of hemoglobin. Hemoglobin is an important protein in red blood cells that carries oxygen through your blood vessels. Some chronic conditions that cause inflammation can affect how your body stores and uses iron.
With inflammation, the body's immune system releases certain proteins, called cytokines. These proteins can interfere with the process of red blood cell production and prevent iron in your bone marrow from entering into red blood cells. Cytokines also lower the bone marrow's response to erythropoietin—a protein that stimulates red blood cell production.
Conditions That Cause ACD
There are many causes of inflammation in the body, but the following conditions can cause anemia of chronic disease and produce inflammation:
Diagnosis
If you're experiencing symptoms of anemia or have an underlying diagnosis of one of the conditions that can cause ACD, it's a good idea to see your healthcare provider for testing. Your provider will ask about your symptoms, take your medical history, and perform a physical exam.
After they learn more about your condition, they can order blood tests to help identify the type of anemia you're experiencing and confirm a diagnosis. These tests may include:
1. Complete blood count (CBC): Checks your red blood cell and hemoglobin levels
2. Blood smear: Takes a sample of your blood and views it under a microscope to look at the shape, size, and color of your blood cells
3. Iron test: Looks at how much iron and ferritin (a protein that stores iron) you have in your body to help differentiate ACD from iron deficiency anemia
Sometimes, more invasive testing is required for diagnosis. A bone marrow biopsy is a procedure that occurs when your provider uses a needle to take a sample of tissue from the inner part of the bone. This provides information on your body's ability to make red blood cells and whether you have certain cancers.
Treatments for Anemia of Chronic Disease
The main goals of treatment of ACD are to treat the underlying cause of the problem, restore red blood cell levels, and improve your symptoms. Since ACD is caused by inflammation, it's essential to find and treat the source of your condition.
Your exact treatment plan will depend on the underlying cause of your ACD. For example, if an infection is the root cause of your ACD symptoms, you may need medications like antibiotics or antivirals. Other medical treatments such as corticosteroid medications and immune-modulating therapies can treat inflammatory conditions. An important part of the diagnostic process is to figure out what's causing your ACD so your provider knows how to treat it properly.
Other common treatments for ACD may include:
1. Iron supplements
2. Injectable medications called erythropoietin-stimulating agents which can help your kidneys if they are not making enough erythropoietin
3. Blood transfusion to improve red blood cell counts if your levels drop to less than 7 grams per deciliter (g/dL)
How to Prevent ACD
It's not always possible to prevent ACD. But if you have an underlying condition, it's important to see your provider regularly for checkups. It's also important to make an appointment with your provider if you experience any symptoms of ACD.
However, you can follow these tips to help lower your risk of ACD and other chronic health conditions:
1. Keeping your blood pressure and blood sugar levels in check
2. Avoiding IV drug use which can increase your risk of infections
3. Getting care for your underlying health conditions and following your treatment plan properly
If your healthcare provider has diagnosed you with any kind of anemia, it's important to pay attention to your symptoms and follow your treatment plan. Eating a diet rich in iron or taking iron supplements can also help prevent complications from anemia.
Complications
If your condition is left untreated or occurs alongside other anemias, ACD can cause complications like angina (chest pain due to low blood flow to the heart). ACD can also worsen underlying health conditions, like heart failure or coronary artery disease.
ACD during pregnancy can also cause certain problems. During pregnancy, the developing fetus requires its own hemoglobin. It's common for pregnant people to have lower blood counts due to the expansion of blood volume that happens during pregnancy, but significant anemia can lead to premature birth and growth problems for the fetus.
How Has Chronic Disease Affected You? We Want to Know.
I’m Knvul Sheikh, a reporter on the Well desk at The New York Times, where I cover health and wellness. I’ve written about the seemingly never-ending cycle of flu cases, coughs and colds, as well as how to reduce your exposure to chemicals in personal care products and how to make sense of your cholesterol test results.
In the year ahead, I will be deepening my coverage of chronic diseases like diabetes and heart disease. More than half of Americans have at least one chronic disease, and many have two or more.
I’d love to hear about your experiences with these ailments, and what issues you think warrant more attention. Have medication costs made it difficult to manage your diabetes effectively? Has a stroke or heart attack changed how you think about your heart health? Have you been able to lower your cholesterol with lifestyle changes like a different diet or exercise routine?
I will never publish anything without your explicit permission. I also will not use your contact information for any other purpose or share it outside our newsroom.
Chronic wasting disease confirmed in British Columbia
Chronic wasting disease is continuing its slow march around the continent.
Wildlife officials in British Columbia announced earlier this month that the always-fatal disease was confirmed in the southeastern part of the province.
A male mule deer killed by a hunter and a female white-tailed deer that had been hit by a car tested positive for the disease.
They are the first animals to test positive in British Columbia, which had stayed clean for years despite known hotspots not far from its borders.
Jesse Zeman, executive director of the B.C. Wildlife Federation, said in a news release that the disease can be devastating for populations of elk and deer, and that the province will need to stay vigilant for additional detections.
“We have been watching CWD spread province to province, state to state for at least 20 years, so this is terrible news for British Columbians,” Zeman said.
Chronic wasting disease is caused by misfolded proteins called prions, and it attacks an animal’s nervous system. Elk, moose, deer and caribou can become infected. The disease is not known to affect humans, though health officials advise against eating infected meat.
Between animals, however, it’s easily transmissible, particularly in dense populations. High prevalence rates could cause problems in deer or elk populations by reducing the number of animals that make it to adulthood, according to the CWD Alliance.
More than 30 U.S. states have confirmed the disease, including Idaho and Montana. With the addition of British Columbia, it’s now been found in five Canadian provinces.
The two infected animals were found near Cranbrook, which is in southeastern British Columbia, north of Montana and close to the Alberta border. The disease has been known to be in Montana and Alberta for years.
British Columbia ordered mandatory testing for deer killed in hunting districts along both borders in 2021.
The fact that the detections were still east of the Idaho border means they create no new urgency for wildlife managers in Idaho or Washington, though officials in both states said this week that the finding is concerning.
“It’s a little ways up there, but it’s still too close for comfort,” said Staci Lehman, a spokesperson for the Washington Department of Fish and Wildlife.
Washington is one of a handful of Western states that has yet to record a case of chronic wasting disease. Officials have been encouraging hunters to submit samples for years, and they’ve also been testing road-killed animals.
As of this week, WDFW had gathered close to 700 samples, Lehman said, and all that have been tested were negative.
She said Washington would continue testing as usual in northeastern Washington, aiming to “get as many deer as we can tested.”
TJ Ross, a spokesman for the Idaho Department of Fish and Game’s Panhandle region, said the news from British Columbia confirms the disease exists north and east of the Panhandle, but that it won’t change the state’s surveillance strategy.
“We know it’s there,” Ross said. “We’re going to continue sampling.”
Chronic wasting disease is known to exist in central Idaho. Officials found it north of Riggins in 2021, and officials confirmed a case near the town of New Meadows last fall. But officials have been watching the panhandle closely since CWD showed up in parts of western Montana that are close to the Idaho border.
Ross said the agency typically tests between 300 and 400 animals from the Panhandle each year, with a particular focus on the Bonners Ferry area. This past hunting season, the state tested 350 samples, all of them negative.
::Frequently Asked Questions::
When is anemia life-threatening?
Anemia can be life-threatening when blood counts are severely low, or when it occurs rapidly, such as in severe bleeding. Severely low blood counts impair the oxygen delivery to the body's tissues, including the brain and heart, which can cause fainting, abnormal heart rhythms, and death.
What hemoglobin level requires blood transfusion?
Blood transfusions may be necessary if your hemoglobin levels drop below 7 grams per deciliter. However, you may need a blood transfusion at higher blood counts if anemia is causing more severe symptoms or worsening symptoms of underlying conditions like heart failure.
Can anemia cause heart disease?
Anemia and heart conditions are related. Anemia and heart failure commonly occur together, each making the other condition worse. Longstanding and untreated anemia can cause a form of heart failure. Significant anemia can also worsen symptoms and outcomes in coronary artery disease. People with heart conditions should talk with their healthcare provider about treating anemia
