Anemia due to chronic diseases


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This is the second most common form of anemia. Because of a chronic illness kick the Anemia as a consequence or accompanying symptom.

Cause and development of the disease (pathophysiology)

The hormone erythropoietin (also known as EPO), which is mainly produced by a lack of oxygen in the kidneys, but also partly in the liver, is important as a growth factor.
It reaches the blood-forming system in the bone marrow via the bloodstream and, as a transcription factor, stimulates erythropoiesis. It thus has an anti-apoptotic effect, i.e. it prevents the premature breakdown of precursor cells in the bone marrow.

Also read: Anemia in old age - dangerous?

With chronic inflammation in the body, this function is inhibited. If the iron content is sufficient, the cells can still fully mature. However, if the inflammation continues for a long time, there will also be one disturbed iron utilization. The inflammation also affects EPO formation. As a result, the red blood cells are too small and can carry less oxygen (microcytic hypochromic anemia).
The causes are on the one hand Tumor diseases to call.
Furthermore, chronic infections such as:

  • a Inflammation of the lining of the heart (Endocarditis lenta)
  • Softening of the bones (osteomyelitis)
  • tuberculosis

be causative.

However, the most common is chronic inflammation such as rheumatoid arthritis (Inflammation of the joints, "rheumatism"), intestinal diseases (Crohn's disease, Ulcerative colitis), Systemic lupus erythematosusLupus erythematosus i.a. the reason. A weakness in kidney function (renal failureRenal failure) is the most common cause of erythropoietin deficiency.


The blood count shows increased inflammation values ​​such as

  • CRP (C-reactive protein)
  • white blood cells (leukocytes).

The oxygen transporting protein Hemoglobin (Hb) is diminished.
The red blood cells can be normal (normochromic-normocytic) or smaller (microcytic-hypochromic).
The iron content in the blood is reduced, ferritin increased. The number of red blood cells is lower. In addition, parameters such as the soluble transferrin receptor and reticulocyte hemoglobin allow the demarcation to one Iron deficiency anemia to.


Therapy consists of eliminating the cause, if possible. A substitution of the hormone Erythropoietin (EPO) is possible, but expensive.