Biology Reference
In-Depth Information
Use of recombinant erythropoietins for the
treatment of anemia of chronic disease
Robert T. Means, Jr.
Hematology/Oncology Division, Ralph H. Johnson Veterans Affairs Medical Center and the Medical
University of South Carolina, 903 CSB, 96 Jonathan Lucas Street, Charleston SC 29425, USA
Introduction
The term “anemia of chronic disease” (ACD) is used to describe a hypoprolif-
erative anemia syndrome typically observed in patients with chronic infec-
tious, inflammatory, or neoplastic disorders, and which is characterized diag-
nostically by hypoferremia despite adequate reticuloendothelial iron stores.
ACD is often considered an unsatisfactory name, given that it does not include
the anemias associated with many chronic conditions (such as chronic thyroid
deficiency or end-stage renal disease), but does include the anemia observed
in the context of acute infection or inflammation [1]. Unfortunately, most of
the proposed alternatives are similarly deficient, being either purely descrip-
tive (anemia of infection, anemia of inflammation, anemia of cancer), or, if
they attempt to define ACD pathophysiologically, do so in an incomplete man-
ner (anemia of defective iron reutilization). The most pathophysiologically
accurate alternative name, “cytokine-mediated anemia”, has never achieved
common use [2].
Regardless of what it is called, ACD is clearly one of the most common
hematologic syndromes observed in clinical medicine. In one series from the
mid-1980s, ACD was diagnosed in more than 50% of the anemic patients
admitted to the wards of a busy urban hospital [3]. Approximately 25% of out-
patients followed for rheumatoid arthritis [4], and more than 50% of newly
diagnosed inpatients on rheumatology services have ACD [5]. It is also strong-
ly associated with chronic infections such as tuberculosis, empyema and lung
abscess, endocarditis, cellulitis, and osteomyelitis [6, 7]. Most of patients with
tuberculosis or endocarditis in modern series have ACD [8-10]. A syndrome
essentially indistinguishable from ACD is observed in 5% to 17% of children
with acute infections [11] during the first month after surgery [12], and also in
critically ill patients in intensive care units [13].
