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Anemia of Chronic Disease

This page was written by Shelley Ensz, and has not yet been medically edited. Inspiration, personal story and several links for this page were provided by Sherrill Knaggs. See Disclaimer.

Overview
What is Anemia?
Types of Anemia
Symptoms of Anemia
Diagnosis of Anemia

What is Anemia of Chronic Disease?
Causes of Anemia of Chronic Disease
Treatments for ACD
Personal Stories about ACD

Overview

Anemia refers to a deficiency in the blood. Anemia most commonly refers to insufficient iron resulting in a shortage of hemoglobin, but the term is also used to indicate vitamin deficiency or blood loss. Anemia can range from mild and temporary to severe and life-threatening. When the anemia is caused by a chronic illness, it is called "anemia of chronic disease."

What is Anemia?

Anemia: Overview. Many types of anemia exist, each with its own cause. The cause may be an iron or vitamin deficiency, blood loss, a chronic illness, or a genetic or acquired defect or disease. It may also be a side effect of a medication. Anemia can be temporary or long-term. It can range from mild to severe. Mayo Clinic.

Aplastic anaemia. Aplastic anaemia is a rare haemopoietic stem-cell disorder that results in pancytopenia and hypocellular bone marrow. Acquired aplastic anaemia can be effectively treated by allogeneic bone-marrow transplantation, immunosuppression (generally antithymocyte globulin and cyclosporin), and high-dose cyclophosphamide. PubMed. Lancet. 2005 May;365(9471):1647-56.

Types of Anemia by Sherrill Knaggs

I often become quite severely anemic, but although I started off with the anemia of chronic disease, it became much more serious when my kidneys failed, and I now have the anemia of kidney failure. (Also see: Sherrill Knaggs: My Experience with Anemia)

In both anemia of chronic disease and of kidney failure I was treated with iron infusions by IV. I was told that only about 10% of iron tablets are absorbed by most people regardless of whether they have an autoimmune disease or not, so the iron by IV is much better absorbed. I have proved that too, as each time I have had an iron infusion I come right quite quickly.

Generally speaking B12 injections are usually used for a different sort of anemia called pernicious anemia. In the UK, by far the most common cause of vitamin B12 deficiency is a lack of 'intrinsic factor', a substance which is produced in the stomach and enables the body to absorb vitamin B12 from the diet. Sometimes doctors add B12 for other reasons to treatment with iron, but it doesn't pay to self dose with B12. NetDoctor.com.uk.

To know whether you are deficient with this you should have a blood test. I had one a while back, and my levels were fine, though my iron levels were not.

Sometimes folic acid is also needed as this helps with the manufacture of red blood cells, but once again should not be taken without consulting your doctor.

I was once given B12 injections by a doctor, and I didn't need them. It made my heart do very strange things! If you read the webpage above about B12 deficiency you will find more information, including other possible causes of this deficiency. One is the formation of antibodies against the cells producing intrinsic factor. The cells then die and B12 deficiency and anaemia (also called pernicious anaemia) develop. Maybe an autoimmune disease can form these antibodies. And it is entirely possible for a patient to have both sorts of anemia simultaneously.

Symptoms of Anemia

Anemia: Signs and Symptoms. The main symptom of most types of anemia is fatigue. Other signs and symptoms of anemia include: Weakness; Pale skin, including decreased pinkness of your lips, gums, lining of your eyelids, nail beds and palms; A rapid heartbeat; Shortness of breath; Chest pain; Dizziness; Irritability; Numbness or coldness in your hands and feet; Headache. Mayo Clinic.

Anemia associated with greater risk of death in heart disease patients. A new study appearing in Congestive Heart Failure has found that the presence of anemia in patients with chronic heart failure is associated with a significantly increased risk of death. Physorg.com. 05/28/09.

Diagnosis of Anemia

Diagnosis/Symptoms of Anemia. Extensive information, including blood tests for anemia, treatments, nutrition, and specific conditions related to anemia. Medline Plus.

What is Anemia of Chronic Disease?

When the anemia is caused by a chronic illness, it is called "anemia of chronic disease."

Anemia could be beneficial response to chronic disease, study says. The authors argued that anemia of chronic disease is a beneficial and adaptive response to a patient’s disease. The body has adapted over thousands of years to be anemic at times of stress because it needs to conserve energy. Renal Business Today. 08/12/2008.

Anemia of Chronic Disease. Conditions associated with the anemia of infection and chronic diseases include such diverse diseases as chronic bacterial endocarditis, osteomyelitis, juvenile rheumatoid arthritis, rheumatic fever, Crohn's disease, and ulcerative colitis. Chronic renal failure may produce a similar anemia because it causes reduced levels of erythropoietin, the hormone which stimulates the production of red blood cells in the bone marrow. HealthCentral.

Causes of Anemia of Chronic Disease

Increased risk of anemia in dialysis patients with comorbid diseases. Recent analyses conducted by the United States Renal Data System indicate that dialysis patients with concomitant comorbidities such as systemic lupus erythematosus, multiple myeloma, acquired immunodeficiency syndrome, or other secondary glomerulonephritis/vasculitis are at greater risk for anemia. PubMed. Nephrol Nurs J. 2004 Mar-Apr;31(2):211-4. (Also see: Dialysis)

Anemia in Kidney Disease and Dialysis Anemia is common in people with kidney disease. Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys, however, often do not make enough EPO. As a result, the bone marrow makes fewer red blood cells. If no other cause for EPO deficiency is found, it can be treated with a genetically engineered form of the hormone, which is usually injected under the skin two or three times a week. NIDDK. (Also see: Dialysis)

Watermelon Stomach belongs to a group of gastrointestinal (GI) bleeding problems which are referred to as Arteriovenous Malformations (AVMs.) Untreated, AVMs can cause chronic anemia or acute (sudden or severe) GI bleeding. AVMs can also cause vomiting of blood (hematemesis) or dark, tarry stools which contain blood (melena.) ISN.

Low-titer cold agglutinin disease with systemic sclerosis. A 60-year-old woman with systemic sclerosis (SSc) was admitted because of severe anemia and Raynaud's phenomenon. She was diagnosed as low-titer cold agglutinin disease rousing secondarily to SSc. PubMed. Intern Med. 2004 Feb;43(2):139-42. (Also see: What is Scleroderma? and Raynaud's)

A 60-year-old male patient having systemic scleroderma and normotensive scleroderma renal crisis. Before admission he had been treated with high doses of corticosteroids. We believe corticosteroids led to the worsening of renal damage with renal failure, microangiopathic hemolytic anemia without high blood pressure. PubMed. Medicina (B Aires) 2003;63(1):49-50. (Also see: Kidney Involvement)

Treatment of Anemia of Chronic Disease

Treating Anemia. Because anemia itself is not a disease but a sign of some other process, the best way to minimize the symptoms of anemia at home is to control other medical problems. eMedicine.

Iron homoeostasis in rheumatic disease. Altered iron homoeostasis may represent a purposeful response to inflammation that could have theoretical anti-inflammatory benefits. Physicians should avoid routine iron supplementation in those without depleted iron stores. Joshua F. Baker. Rheumatology. July 23, 2009 (Also see: Vitamins)

Efficacy of anti-thymocyte globulin and cyclosporin A combined therapy in aplastic anemia complicated with limited cutaneous systemic sclerosis. The use of this therapy resulted not only in marrow recovery but also in resolution of the skin sclerosis. PubMed. Nihon Rinsho Meneki Gakkai Kaishi. 2005 Apr;28(2):99-103.

Personal Stories of Anemia

Anna: Linear Scleroderma (Poland) I realised that it is not worthwhile to give up, even during the most difficult moments; it is necessary to fight and to believe that it will be better. If I had not believed I would not have been alive now...

Aurora: Linear Scleroderma I am always very tired, and I suffer from pain that will not go away no matter what I do...

Dawn M: Linear/Systemic Scleroderma My family and I were informed by the doctors, that the localized/linear form of scleroderma that I was diagnosed with, would never progress into the potentially fatal, systemic form...

Doni: CREST Syndrome The doctors were always interested like, "Wow look at this," but since I had no insurance, they would not touch me...

Dorne: Overlap and Possibly CREST Since 2002 I have been diagnosed with Lupus, Sjogren's Disease, B12 deficiency, mild pulmonary hypertension, Celiac disease, Type II diabetes and now the specialists are seriously talking about CREST...

Jody: Fibromyalgia/Difficult Diagnosis In Sudan, I was on IV for heat stroke and food poisoning. And in Thailand, at the end of March, it all came to a crashing halt...

Karligash: Systemic Scleroderma (Republic of Kazakhstan) Young, beautiful, full of hope and expectations for my life, for happiness and love — that was me, nineteen years of age...

(Russian) Карлыгаш: системная склеродермия (Республика Казахстан) Молодая,красивая,полная ожидания от жизни счастья,любви такая я была в 19 лет...

Kaycee: Diffuse Scleroderma with Polymyositis The rheumatologist confirmed the diagnosis of diffuse scleroderma on my initial visit to him. Since then, I have had a muscle biopsy, which confirmed polymyositis...

Keri: Undiagnosed I have been living with back pain, stomach problems and skin problems since I was a teen...

Leslie R: Scleroderma, Vitiligo, Lupus, Anemia, Hypertension and Type 2 Diabetes He told me that I have scleroderma and explained what this disease is about. After suffering so long I finally got some answers...

Rosie: Limited Systemic Sclerosis (Australia) Some of my symptoms may not be due to limited scleroderma, however most of these symptoms have appeared since my diagnosis...

Sherrill: My Experience with Anemia Since I became ill with diffuse scleroderma just over eight years ago, I have found that anemia is a quite complex subject...

Sue D: Diffuse Scleroderma Pain developed in my hands, then I noticed pain in my knees, then my shoulders, down my back, elbows, hips, feet...

Yuri: CREST Syndrome Now, one month before my nineteenth birthday, I live with CREST Syndrome, rheumatoid arthritis, acid reflux and anemia...