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Anemia of Chronic Disease

Anemia of Chronic Disease (ACD), also known as Anemia of Inflammation. It is a form of anemia where the body is not deficient in iron but instead stores the iron as ferritin within cells and doesn't release it as to keep it away from pathogens that need it for proliferation. As a result, signs of anemia may develop. It is not uncommon in those with Crohn's Disease, other IBD, and other chronic conditions. Iron Deficiency Anemia (IDA) and Anemia of Chronic Disease have many similarities and can be confused.

Similarities Between ACD and IDF

  • In both Iron Deficiency Anemia and Anemia of Chronic Disease, serum iron levels will be low.
  • Both usually have lowered levels of hemoglobin.


Tests to help determine if someone has Anemia of Chronic Disease instead of Iron Deficiency Anemia include:
  • Ferritin levels should be normal or high in people with ACD which showcases sufficient levels of iron stored within the cells. Those with iron deficiency anemia should have low levels of ferritin. However, inflammation can affect ferritin levels.
  • Total Iron Binding Capacity (TIBC) should be high in those with iron deficiency anemia which reflects the body trying to bind up as much iron as possible. Those with Anemia of Chronic Disease should have low or normal TIBC. Transferrin, a protein that transports iron, is elevated in iron-deficiency anemia (and low in ACD). TIBC is an indirect check of Transferrin levels.
  • Hemoglobin levels will generally experience a modest decline to around 9.510.5 g/dL but may drop to 7.0 g/dL depending on the extent of inflammation.
  • Examination of bone marrow can be done to determine the presence or lack of iron.
  • Iron supplementation can be provided. Those with ACD should not show improvement whereas those with iron deficiency should quite quickly.


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02-26-2012, 11:05 AM   #1
Join Date: Nov 2011
Location: Canada
This is very helpful and interesting information, thanks David.

I have crohn's and recently been having low hemoglobin levels, 97 g/L on last test, and here in Canada I think they recommend a minimum of 140 g/L for adult males. The specialist gave me iron supplement tablets to correct this, but I have not been able to tolerate them. When I later saw my family doctor he suggested iron injections instead of the tablets. However, he did not want to give me injections until my ferritin levels were checked, as he said the low hemoglobin may not necessarily be caused by low iron. According to this article, it seems he is correct.

I am currently waiting on the blood test results for the ferritin and will see the specialist again in a weeks time. Will be very interesting to see the results and what he plans to do about it. Me having this information will be very helpful. Thanks again.

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