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Anemia of inflammation results from hepcidin-induced hypoferremia combined with cytokine-mediated suppression of erythropoiesis and decreased lifespan of erythrocytes.
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Treatment of the cause of inflammation improves the anemia.
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Treatment with erythropoiesis-stimulating agents and/or intravenous iron is rarely necessary.
Anemia of Inflammation
Section snippets
Key points
Clinical presentation
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Mild to moderate anemia (hemoglobin rarely <8 g/dL)
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Occurring in a setting of infection, inflammatory disease, or malignancy
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Low serum iron
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Systemic iron stores not depleted
Pathophysiology
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Mildly shortened erythrocyte survival (increased destruction)
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Hypoferremia, iron-restricted erythropoiesis from cytokine-stimulated hepcidin increase
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Suppression of erythropoiesis by direct effects of cytokines on the marrow
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Variable effects of inflammation on erythropoietin production, renal excretion of hepcidin
Treatment of AI
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Treat the underlying disease
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Treat anemia specifically only if severe or limits activities of daily living
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Erythrocyte transfusion for acute symptoms
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Erythropoiesis-stimulating agents (ESAs) with or without IV iron (off-label treatment)
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Experimental therapies under development include new ESAs, anticytokine drugs, and agents targeting the hepcidin-ferroportin pathway
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