Turkish Journal of
GERIATRICS

Gülhane Askeri Tıp Akademisi, İç Hastalıkları Anabilim Dalı, Ankara
Gülhane Askeri Tıp Akademisi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara Anemia of chronic disease (ACD) is found in elderly patients or those with chronic illness such as cancer, chronic infection (osteomyelitis, infective endocarditis, pelvic inflammatory disease, chronic urinary tract infection, tuberculosis, chronic fungal disease) or inflammation (rheumatoid disease, SLE, burns, severe trauma, acute and chronic hepatitis). The degree of the anemia usually depends upon the severity of the underlying disease. At least three factors are implicated in the pathology of this type anemia. The first is a shortened life span of the red blood cell (RBC). The normal life span of a RBC is 120 days. in ACD, this number decreases to 60 to 90 days. It is felt that this may be due to some type of substance or factor which acts to decease RBC survival. Fever may also contribute to this shortened survival by damaging the RBC. The second factor in the pathogenesis of ACD is decreased iron absorption from the GI tract. Third and the last factor is an impaired erythropoietin response of the bone marrow to the decreased RBC life span and the pseudoiron deficiency. Patients with ACD usually present with a mild to moderate anemia, with a hemaglobulin rarely less than 8 gr/dl. This anemia develops gradually and the stabilizes at hematocrit levels between 25% to %40. ACD usually have normal MCVs, but in approximately 15% to 20% of patients the MCV can be low. If MCV is low or normal, iron metabolism testing would be indicated. Rarely this anemia is the initial manifestation of an occult process such as inflammatory or malignant disease in the body. Once the diagnosis of ACD is established, the clinician should extend the investigation to establish a cause. Therapy consists of treating the underlying illness and, if necessary transfusion of the packed RBC. Some patients will respond to recombinant erythropoietin injections, which have been shown to result in improved hemoglobin and hematocrit and enhanced quality of life. Keywords : Anemia of chronic disease, Iron deficiency anemia, Erythropoietin, Elderly, Geriatrics