Anemia of Inflammation

Anemia of inflammation (AI, formerly known as anemia of chronic disease) is a common, usually mild form of normocytic normochromic anemia (hemoglobin typically >8.0 g/dL), which is caused by an underlying inflammatory or autoimmune disease, infection, or neoplasm. AI is the second most prevalent cause of anemia worldwide (after iron-deficiency anemia [IDA]) and is also the most common cause of anemia among hospitalized or chronically ill patients. Primarily, AI was attributed to chronic illnesses with sustained inflammatory states like infections, malignancies, and autoimmune diseases. Recently, other chronic conditions, including chronic obstructive pulmonary disease, obesity, chronic liver disease, congestive heart failure, and advanced atherosclerosis, including stroke and coronary artery disease, have been related to causation of AI. Patients with AI may also have concomitant true iron deficiency. Identification of superimposed iron deficiency among these patients is important as iron replacement reduces the need for frequent transfusions and helps improve overall quality of life. Management primarily focuses on treating the underlying cause of systemic inflammation, which often varies with the severity of the underlying condition and therapeutic options available. Beside additional therapies, such as iron replacement and blood transfusions, novel treatment options targeting hepcidin and iron trafficking are currently in the pipeline.