Anemia Of Inflammation: Symptoms, Causes, And Treatment

Anemia is a condition that causes low red blood cell levels. Red blood cells are necessary for transporting oxygen to your body's cells. 

Anemia of inflammation is a type of anemia associated with inflammation. Your body mounts an inflammatory response to protect itself from substances perceived as harmful, such as bacteria or irritants. When this happens, your organs and tissues have more difficulty getting oxygen. As a result, you may experience fatigue, weakness, and shortness of breath.

Let’s learn more about this condition, its symptoms, causes, and treatment.

What is anemia of inflammation?

Anemia is a blood disorder where you have a reduced number of red blood cells and hemoglobin in your body. Hemoglobin is a protein responsible for taking oxygen from your lungs to cells throughout the body. Lower-than-normal levels can produce concerning symptoms. 

Your body needs hemoglobin to function correctly, and your body may not get adequate oxygen with fewer red blood cells and less hemoglobin.

Anemia of inflammation, also called anemia of chronic disease or ACD, is a form of anemia that affects people with conditions that cause inflammation. These conditions include infections, autoimmune diseases, cancer, or chronic kidney disease. 

If you have anemia of inflammation, you may have a normal or even increased amount of iron stored in your body tissues but low levels of iron in your blood. Inflammation may prevent the body from using stored iron and making enough healthy red blood cells, causing anemia.

What are the symptoms of anemia of inflammation?

Symptoms vary depending on how quickly your hemoglobin levels decrease and on the underlying cause. Anemia of inflammation usually develops slowly, causing vague symptoms like tiredness, weakness, shortness of breath, and headaches.

Many people don't notice any symptoms and only experience symptoms of the underlying condition causing anemia. When anemia is acute, symptoms may include confusion, feeling faint, loss of consciousness, and increased thirst.

Symptoms of anemia of inflammation are similar to any form of anemia and include:

• Rapid heartbeat

• Body aches

• Fainting, dizziness, or lightheadedness

• Feeling tired or weak

• Becoming tired from physical activity quickly 

• Pale skin

• Shortness of breath

What are the causes of anemia of inflammation?

Your body produces red blood cells in your bone marrow, and these cells have an average lifespan of 100–120 days. On average, your bone marrow produces about two million red blood cells every second, and around the same number are withdrawn from circulation. In addition, your body removes and replaces about 1% of your red blood cells daily.¹ ²

Any process that disrupts this delicate balance between producing and destroying red blood cells can lead to anemia.

Medical experts believe anemia of inflammation occurs when an infection or disease causes inflammation, affecting your immune system and changing how your body works. These changes may mean:

• Your body destroys your red blood cells prematurely, causing them to die before it can replace them.

• Your body is not storing and using iron normally.

• Your kidneys produce less erythropoietin, the hormone that signals the bone marrow to produce more red blood cells.

• Your bone marrow may not respond to erythropoietin as it should, making fewer red blood cells than you need.

Conditions that cause anemia of inflammation

Many chronic conditions can cause inflammation that leads to anemia, including:

• Rheumatoid arthritis, lupus, or other autoimmune diseases

• Cancer

• HIV/AIDS, tuberculosis, or other chronic infections

• Chronic kidney disease (CKD)

• Inflammatory bowel diseases, such as ulcerative colitis and Crohn's disease

• Other chronic conditions that involve inflammation, such as diabetes and heart failure

In some people with chronic conditions, there may be more than one cause of anemia. For instance:

Causes of anemia in people with chronic kidney disease may include:

• Inflammation

• Low levels of erythropoietin caused by kidney damage

• Insufficient amounts of the nutrients necessary to make red blood cells

• Hemodialysis, a chronic kidney disease treatment, may also cause an iron deficiency that leads to anemia.

• In people with cancer, causes of anemia include: 

  • Blood loss

  • Inflammation

  • Cancers that affect the bone marrow

  • Cancer treatments may also cause or worsen anemia.

• People with inflammatory bowel diseases may experience anemia of inflammation and iron-deficiency anemia due to blood loss.

Less common causes of inflammation that might lead to anemia

While anemia of inflammation usually develops slowly and produces few noticeable symptoms, anemia of critical illness is a form of anemia of inflammation that develops quickly. 

This type of anemia of inflammation typically occurs in people hospitalized for trauma, severe acute infections, or other conditions that cause inflammation.

In some older adults, anemia of inflammation unrelated to any underlying infection or chronic disease develops. Medical experts believe the body's natural aging process causes this.

What are the different types of anemia?

According to the Centers for Disease Control and Prevention, anemia is the primary diagnosis of nearly 900,000 emergency room visits and is responsible for over 5500 deaths annually.³

If you have anemia, your body doesn't get enough oxygen-rich blood to function properly. The lack of oxygen can cause shortness of breath and dizziness and leave you feeling tired and weak.

There are several types of anemia, including:

• Iron deficiency anemia: When your body doesn't receive adequate supplies of iron

• Pernicious anemia: This condition is due to a lack of vitamin B12

• Hemolytic anemia: Where the body destroys red blood cells earlier than normal

Risk factors for anemia of inflammation

Many conditions can cause anemia, a common condition that can develop in anyone. Anemia of inflammation has many causes and may signify another health condition. Some of the most common risk factors include:

Age

Your chances of developing anemia increase as you get older.

Blood loss

Blood loss is another common cause of anemia. Women who experience heavy bleeding during their menstrual cycle have an increased risk of developing anemia. 

Blood loss from an internal disorder, such as peptic ulcer, colon polyp, or colorectal cancer, is also associated with iron-deficiency anemia. 

If other risk factors are present, heavy bleeding, such as from surgery, a severe injury, or donating blood, can also lead to anemia.

Family history

You may have an increased risk if you have a history of hereditary anemia.

Lifestyle habits

You are at a higher risk of developing anemia if your diet is nutritionally deficient and lacks nutrients such as iron, vitamin B12, and folic acid, which your body needs to make healthy red blood cells. Additionally, drinking excessive amounts of alcohol also raises your risk.

Other health conditions

Your body may produce fewer red blood cells if you have a severe medical condition, such as chronic kidney disease, cancer, inflammation from an infection, or an autoimmune disorder. This leaves you at a greater risk of anemia. Some medicines and treatments, such as chemotherapy, can raise your risk of anemia.

Complications associated with inflammatory anemia

Anemia of inflammation is the second most common type after iron deficiency anemia. Most cases are mild to moderate, meaning that while hemoglobin levels are lower than usual, they are not dangerously low and may cause few symptoms. 

When anemia is severe, you may have symptoms that include feeling extremely tired or shortness of breath. Left untreated, severe anemia of inflammation can cause many health issues and even become life-threatening.

Complications from anemia of inflammation include:

Extreme fatigue

Severe anemia can make you so tired that it is difficult to complete routine everyday tasks.

Pregnancy complications

Pregnant women with folate deficiency anemia have a greater risk of complications during pregnancy, such as premature birth and congenital neurological disabilities.

Heart problems

Anemia can cause an irregular or rapid heartbeat. When you have anemia, your heart pumps more blood through your body to try and make up for the lack of oxygen in your blood. This can lead to an enlarged heart or even heart failure.

Death

Some inherited types of anemia can cause life-threatening complications, such as sickle cell anemia. Rapid blood loss can result in acute, severe anemia, which can be fatal. In addition, older adults who develop anemia have an increased risk of death.

What is the treatment for anemia of inflammation?

The first step to treating anemia of inflammation is to treat the underlying condition causing the inflammation. If a treatment can reduce the inflammation, it may improve the anemia or cause it to go away completely. For instance, if the inflammation is due to rheumatoid arthritis, taking medications to treat the inflammation may improve the anemia.

A physician may prescribe erythropoiesis-stimulating agents (ESAs) or darbepoetin alfa to treat anemia related to chronic kidney disease, chemotherapy treatments, or HIV treatments. ESAs cause the bone marrow to produce more red blood cells. 

Erythropoiesis-stimulating agents are typically in injection form, and your healthcare professional may teach you how to use these shots at home. In addition, they may prescribe iron supplements as a shot or pill to increase the effectiveness of the ESA.

In severe cases of anemia of inflammation, your physician may order blood transfusions, which can quickly raise the hemoglobin and oxygen levels in your blood.

The lowdown

Anemia of inflammation is a type of anemia that affects people with conditions that cause inflammation. One of the most common causes of anemia is a lack of nutrients, such as iron, folate, or vitamin B12. 

While mild to moderate cases of anemia of inflammation often have little or no symptoms, if the condition worsens without treatment, it can lead to serious health consequences and even death. If you’re concerned about anemia, speak to your doctor for their advice.