ANEMIA OF CHRONIC DISEASE: PATHOGENESIS, DIAGNOSTIC CHALLENGES, AND TREATMENT APPROACHES

Abstract

Anemia of chronic disease (ACD), also known as anemia of inflammation, is one of the most common forms of anemia observed in patients with chronic infections, autoimmune disorders, malignancies, chronic kidney disease, and other long-standing inflammatory conditions. This type of anemia develops through complex interactions between the immune system, iron metabolism, and erythropoiesis. The main mechanisms include increased hepcidin production, reduced intestinal iron absorption, impaired release of stored iron, decreased erythropoietin activity, and suppressed bone marrow response. As a result, patients develop iron-restricted erythropoiesis despite normal or increased iron stores. The present article reviews the current understanding of the pathogenesis, laboratory characteristics, differential diagnosis, and treatment strategies of anemia of chronic disease. Special attention is given to the distinction between ACD and iron deficiency anemia, since these conditions may coexist and create diagnostic difficulty. The reviewed evidence shows that accurate diagnosis requires combined interpretation of hemoglobin levels, ferritin, transferrin saturation, inflammatory markers, and the clinical background of the patient. Management of ACD is primarily based on treatment of the underlying disease, while iron therapy and erythropoiesis-stimulating agents may be used in selected cases. A better understanding of inflammation-driven iron dysregulation, especially the role of the hepcidin-ferroportin axis, may improve future diagnostic and therapeutic approaches.