Synopsis
Recognise inflammation-related iron restriction and impaired erythropoiesis, exclude coexisting deficiency or marrow disease, and treat the underlying disorder while using specialist supportive therapy safely.
- Anaemia of inflammation is usually an underproduction anaemia caused by hepcidin-mediated iron sequestration, reduced erythropoietin effect and shorter red-cell survival; it is commonly normocytic but can become mildly microcytic.
- Make the diagnosis from a compatible active inflammatory, infective, malignant or renal disorder plus iron studies and reticulocytes. A raised CRP alone does not explain severe or progressive anaemia.
- Ferritin may remain normal or high because it is an acute-phase reactant, while transferrin saturation is low. This pattern indicates restricted availability but does not exclude coexisting absolute iron deficiency.
Key red flags
Rapid progression, profound symptoms, additional cytopenias, abnormal cells, haemolysis or bleeding is not explained safely by a stable chronic inflammatory label.
Investigation priorities
Define severity, morphology, trajectory and adequacy of marrow output.
Management branches
Anaemia occurs alongside chronic inflammation, infection, malignancy or kidney disease without immediate physiological instability.
- Review the haemoglobin trajectory, symptoms, bleeding, medicines and active disease, then obtain FBC, film, absolute reticulocytes, ferritin, transferrin saturation, CRP, renal function, B12 and folate.
- The preferred interpretation integrates stores and inflammation: identify absolute deficiency, functional restriction, renal erythropoietin limitation and any bleeding or marrow warning features rather than naming one cause prematurely.
Key medicines
Darbepoetin alfa (specialist CKD example)For adult CKD correction, start 0.45 micrograms/kg subcutaneously or intravenously once weekly; adults not on dialysis may instead start 0.75 micrograms/kg subcutaneously once every 2 weeks, with renal-protocol titration.
Ferrous sulfate for coexisting absolute deficiencyGive one 200 mg tablet by mouth once daily; if gastrointestinal intolerance limits adherence, use one tablet every other day or a different standard oral preparation.