Inflammation and Anemia: What’s the Connection?

3 min read

woman with cancer resting

Whenever you incur an injury — let’s say a cut on your hand — the wound becomes slightly red and swollen for a few days while it’s healing. This healing process is referred to as "inflammation." The area becomes red for a bit and blood flow increases to send immune cells and nutrients to the injury site. Normally, inflammation is an amazing and highly beneficial process.  

But inflammation can sometimes gets out of control and take over the whole body. Certain chronic diseases, such as autoimmune disease, cancer and kidney disease, are all caused by system-wide inflammation. When inflammation is high it can trigger anemia of inflammation, or anemia of chronic disease (ACD). 

What Is Anemia of Inflammation?

When you anemia your body does not have enough red blood cells to efficiently transfer oxygen from the lungs to the rest of the body.

Sometimes, anemia is caused by inadequate iron in the body. In ACD there is adequate iron, but the inflammation causes it to remain in your body’s tissues instead of in the blood. This means the body cannot use the iron to make the red blood cells it needs.

The treatment for ACD is focused on managing the underlying disease. The goal is to decrease inflammation, which will in turn reverse anemia.

ACD is the second most common cause of anemia. The symptoms of ACD are similar to that of other types of anemia, such as fatigue and shortness of breath.

Anemia of inflammation has may have several underlying causes, but how these diseases states cause anemia remains unclear. One theory is that it may be caused by a lack of erythropoietin, a hormone produced by the kidneys that triggers the production of red blood cells (RBCs). This is particularly common in those with chronic kidney disease.

Other causes may be an inability to properly make RBCs, or poorly formed RBCs that die easily due to inflammation. ACD can be aggravated by too many blood draws or digestive issues that lead to blood loss.

Diagnosis of Anemia of Inflammation

In order to diagnosis of anemia of inflammation, a doctor takes a detailed medical history and evaluates the results of various blood tests. A few common tests include: 

  • total iron
  • hemoglobin/hematocrit
  • transferrin, a protein that carries iron
  • ferritin, measures iron in stores in the cells
  • inflammation markers, such as C-reactive protein 

    The doctor will diagnose ACD if ferritin is normal, while transferrin and total iron are low. Generally, for those with ACD, hemoglobin will be moderately low, rarely less than 8 mg/dL.

    This indicates that the body cannot access iron that is stored. Blood test results in combination with a diagnosis of an existing chronic illness may lead a doctor to diagnose ACD. 

    Treatment of Anemia of Inflammation

    The treatment for ACD is focused on managing the underlying disease. The goal is to decrease inflammation, which will in turn reverse anemia. Certain types of medicine may also be used to treat ACD, particularly those that help stimulate erythropoietin. Blood transfusions may be needed if anemia becomes very severe.

    At this time, there is still a lack of understanding around the exact way that ACD develops in people with chronic disease and the best way to treat it. The important thing is to work with your doctor to manage the underlying inflammatory condition,  which will hopefully result in the creation of normal red blood cells.

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