The anaemia of chronic disease

Iron: such a remarkable remedy generally associated with strength and well being. Iron filings dissolved in vinegar were consumed by the ancient Greeks eager to acquire strength, and in 1600 iron was noted for its ability to restore “young girls when pallid, sickly and lacking colour to health and beauty.” Yet strangely it has no effective role in treating the most common type of anaemia to affect hospital inpatients.1 Recent developments have made the anaemia of chronic disease somewhat easier to diagnose, but it remains a puzzling condition. Anaemia of chronic disease was established as a distinct entity in 1962 after studies on the anaemia associated with infection.2 All agree on the “big three” clinical causes: infection, inflammation (including connective tissue disorders), and neoplasia, which account for 75% of cases. Though the chronic disease that leads to the anaemia is usually easily identified, this is not always so, and occult disease must be considered in every case of unexplained anaemia. One special case is the anaemia of chronic renal failure, which is thought to result from a combination of erythropoietin deficiency and anaemia of chronic disease. A further contribution may come from functional iron deficiency consequent on erythropoietin replacement for patients undergoing haemodialysis. In this setting and despite adequate …