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Anaemia of Chronic Diseases (AOCD)

Characteristic features:
  1. Occurs in the setting of chronic infections, chronic inflammation, or neoplasia.
  2. The anaemia is not related to bleeding, haemolysis or marrow infiltration.
  3. The anaemia is generally mild, in the range (8.5 gm% - 11 mg%), and is usually associated with a normal or increased, serum ferritin.
  4. TIBC is low or normal in anemia of chronic disease (LQ 2012)
  5. Transferrin saturation is reduce or normal. (LQ 2012)
The inhibitory effect of various cytokines (Interleukin-1 and TNF-alpha) on erythropoiesis.
Erythropoietin levels appear to be lower than would be accepted for the degree of anemia. 


Extra Edge: Pathophysiology of AOCD
  1. IL-1 directly decreases EPO production in response to anemia. IL-1, acting through accessory cell release of IFN-γ, suppresses the response of the erythroid marrow to EPO—an effect that can be overcome by EPO administration in vitro and in vivo.
  2. In addition, TNF, acting through the release of IFN-γ by marrow stromal cells, also suppresses the response to EPO.
  3. Hepcidin, made by the liver, is increased in inflammation and acts to suppress iron absorption and iron release from storage sites. The overall result is a chronic hypoproliferative anemia.


Management – Treat the basic cause
Cause of anemia Serum iron Serum Ferritin
IDA Decrease Decrease
AOCD Decrease (LQ 2012) Increase (LQ 2012)
Thalassemia Increase Increase


Important Points:     
  1. AOCD & Anemia of chronic renal disease have low reticulocyte count.
  2. In AOCD, TIBC is normal or reduced, transferrin saturation is reduced.


Table - Diagnosis of Hypoproliferative Anemias
Tests Iron Deficiency Inflammation Renal Disease Hypometabolic States
Anemia Mild to severe Mild Mild to severe Mild
MCV (fL) 60–90 80–90 90 90
Morphology Normo-microcytic Normocytic Normocytic Normocytic
S. Iron <30 <50 Normal Normal
TIBC >360 <300 Normal Normal
Saturation (%) <10 10–20 Normal Normal
Serum ferritin (μg/L) <15 30–200 115–150 Normal
Iron stores 0 2–4+ 1–4+ Normal


Important Points:
Transferrin saturation, measured as a percentage. It is the ratio of serum iron and total iron-binding capacity, multiplied by 100.

Usual values

Normal reference ranges are:
  1. Serum iron: 60–170 μg/dl                    
  2. TIBC: 240–450 μg/dl
  3. Transferrin saturation: 15–50% (males), 12–45% (females)

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