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Anemia of Chronic Disease

Anemia of Chronic Disease (ACD), also known as anemia of inflammation, is a type of anemia commonly encountered in clinical practice and is essential knowledge for mastering USMLE Step 1 Pathology. This form of anemia arises secondary to chronic inflammatory conditions, such as infections, autoimmune diseases, and malignancies, where proinflammatory cytokines like interleukin6 (IL6) and tumor necrosis factoralpha (TNFα) inhibit erythropoiesis and disrupt iron metabolism. The hallmark of ACD is the disruption of iron homeostasis, characterized by impaired iron utilization despite normal or elevated iron stores. Inflammatory mediators induce hepcidin production by the liver, which reduces iron absorption from the gut and sequesters iron within macrophages, impairing its release for erythropoiesis. Consequently, patients present with normocytic or microcytic anemia with low serum iron, low transferrin saturation, and normal or elevated ferritin levels. Treatment primarily revolves around managing the underlying inflammatory condition, as correction of the anemia typically follows resolution of the underlying disease process. Understanding the pathophysiology and management of ACD is crucial for physicians to provide comprehensive care to patients with chronic inflammatory disorders.

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