Merck Manual

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Anemia of Chronic Disease

(Anemia of Chronic Inflammation)


Evan M. Braunstein

, MD, PhD, Johns Hopkins School of Medicine

Last full review/revision Sep 2020
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In anemia of chronic disease, inflammation caused by a chronic disorder slows the production of red blood cells and sometimes decreases survival of red blood cells.

(See also Overview of Anemia.)

A chronic disease is one that lasts for 3 months or longer. Worldwide, anemia of chronic disease is the second most common type of anemia.

Chronic disease often leads to anemia, especially in older adults. Conditions such as infections, autoimmune disorders (especially rheumatoid arthritis), kidney disorders, and cancer most often cause anemia of chronic disease. There are three ways that chronic disease may cause anemia:

  • Suppression of the production of red blood cells in the bone marrow

  • Decrease in the lifespan of red blood cells

  • Problems with how the body uses iron

Suppression of red blood cell production is usually not severe, so anemia develops slowly and is evident only after time.

When there is a problem with how the body uses iron, the bone marrow is unable to use stored iron to create new red blood cells.

Because the anemia of chronic disease develops slowly and is generally mild, it usually causes few or no symptoms. When symptoms do occur, they usually result from the disease causing the anemia rather than from the anemia itself.


  • Blood tests

There are no specific laboratory tests to diagnose anemia of chronic disease, so the diagnosis is typically made by excluding other causes of anemia. In people who are diagnosed with anemia of chronic disease, doctors may do blood tests to diagnose the disorder causing the anemia.


  • Treatment of the disorder causing anemia

  • Sometimes drugs to stimulate red blood cell production

Because no specific treatment exists for this type of anemia, doctors treat the disorder causing it. If the disorder causing the anemia does not respond to treatment, erythropoietin or darbepoietin, drugs that stimulate the bone marrow to produce red blood cells, may be given. Iron supplements are usually given when using erythropoietin or darbepoietin to ensure the body reacts appropriately to these drugs. Taking additional iron or vitamins does not help if erythropoietin or darbepoetin is not used.

On the rare occasion that the anemia becomes severe, transfusions may help.

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