The anemia of chronic disease (ACD) is usually defined as the anemia occurring in chronic infectious, inflammatory disorders, or neoplastic diseases, and is one of the most common syndromes in the clinical practice. Characteristically, ACD is a mild-to-moderate, normochromic/normocytic anemia, and is characterized by hypoferremia in the presence of adequate iron stores. The three principal pathologic mechanisms involved in ACD are: reduced erythrocyte survival, bone marrow failure to increase red blood cell production to compensate for the increase in its demand, and abnormal mobilization of reticuloendothelial iron stores. The central role of monocytes and macrophages, and the increased production of the cytokines that mediate the immune or inflammatory response, such as tumor necrosis factor, interleukin-1 and the interferons, are implicated in all three processes involved in the development of ACD. The aim of this article is to review the recent advances in the understanding of the pathophysiologic, diagnostic and therapeutic aspects of this syndrome.
Anemia of chronic disease; erythropoiesis; cytokines; tumor necrosis factor; interleukin; interferon
