Anaemia of chronic disease is a condition where long-lasting illnesses interfere with the body’s ability to produce healthy red blood cells, leaving patients feeling tired and weak despite having normal iron stores trapped in their tissues.

How Treatment Can Help When Your Chronic Illness Affects Your Blood

When someone lives with a long-term health problem such as rheumatoid arthritis, cancer, chronic kidney disease, or a serious infection, they may develop a type of blood disorder that makes everyday activities feel exhausting. This condition, called anaemia of chronic disease, happens when inflammation from a lasting illness interferes with the body’s normal process of making red blood cells. These are the cells that carry oxygen throughout the body, giving organs and tissues the fuel they need to work properly.^[1]

Treatment for anaemia of chronic disease focuses on several important goals. The primary aim is to address the underlying health condition causing the inflammation, since controlling that illness often improves the anaemia naturally. When this approach is not enough, doctors work to reduce symptoms like fatigue and shortness of breath, helping patients maintain their quality of life and ability to carry out daily tasks. For some patients, treatment may also involve supporting the body’s ability to make more red blood cells or, in severe cases, providing transfusions to quickly restore oxygen-carrying capacity.^[4]

The approach to treatment varies considerably depending on how severe the anaemia is, what underlying disease is causing it, and the individual patient’s overall health status. Someone with mild anaemia from well-controlled rheumatoid arthritis might only need adjustments to their arthritis medications, while a person with cancer-related anaemia may require more intensive interventions. Healthcare providers consider factors like age, other medical conditions, and how much the anaemia is affecting daily functioning when designing a treatment plan.^[5]

Standard treatments have been established through years of medical practice and are recommended by professional medical societies. At the same time, researchers continue to investigate new therapies through clinical trials, testing innovative approaches that might offer better outcomes or fewer side effects. These studies explore various types of interventions, from new medications that work on specific molecular pathways to treatments that help the body use iron more effectively despite ongoing inflammation.^[6]

Standard Approaches to Managing the Condition

The cornerstone of treating anaemia of chronic disease is managing the underlying illness that triggers inflammation. When doctors successfully treat conditions like rheumatoid arthritis, inflammatory bowel disease, or chronic infections, the inflammation decreases, and the body often begins producing red blood cells more normally. This means that medications used to control the primary disease become the first line of treatment for the anaemia itself. For example, treating rheumatoid arthritis with anti-inflammatory medications can lower inflammation levels, which then allows the anaemia to improve naturally.^[4]

For patients whose anaemia persists despite treatment of the underlying condition, or when the primary disease cannot be fully controlled, doctors may prescribe erythropoiesis-stimulating agents, or ESAs. These are medications that work similarly to a natural hormone called erythropoietin, which the kidneys produce to signal the bone marrow to make more red blood cells. Two commonly used ESAs are epoetin alfa and darbepoetin alfa. These medications are given as injections, either under the skin or into a vein, typically once or twice a week depending on the specific drug and the patient’s needs.^[4]

ESAs are particularly useful for patients with anaemia caused by chronic kidney disease or cancer. In kidney disease, the kidneys themselves fail to produce enough natural erythropoietin, so replacing it with medication helps restore red blood cell production. For cancer patients, both the disease itself and treatments like chemotherapy can suppress the bone marrow’s ability to make blood cells, and ESAs can help compensate for this effect. However, these medications require careful monitoring because they can have side effects and may not be appropriate for all patients.^[5]

The potential side effects of ESAs include high blood pressure, blood clots, stroke, and heart attack. In cancer patients, there is concern that these medications might stimulate tumor growth in some cases, so doctors weigh the benefits against risks carefully. Patients receiving ESAs need regular blood tests to monitor their hemoglobin levels and ensure they are not rising too quickly or too high, as this increases the risk of cardiovascular complications. The goal is to raise hemoglobin to a safe level that reduces symptoms without creating new health risks.^[5]

For severe anaemia that causes dangerous symptoms like chest pain, severe shortness of breath, or confusion, blood transfusions provide immediate relief. A transfusion involves receiving donated red blood cells through an intravenous line, typically in a hospital or clinic setting. This treatment quickly increases the blood’s oxygen-carrying capacity and can be life-saving in emergency situations. However, transfusions are usually reserved for the most serious cases because they carry their own risks, including allergic reactions, infections, and iron overload if repeated transfusions are needed.^[4]

The duration of treatment varies widely depending on the underlying cause and the patient’s response. Someone whose chronic infection is cured may only need treatment until the infection resolves and inflammation subsides. In contrast, a patient with an incurable chronic disease like advanced cancer or end-stage kidney disease may require ongoing treatment indefinitely. Regular follow-up appointments and blood tests are essential to monitor the anaemia and adjust treatment as needed.^[6]

Beyond medications and transfusions, supportive care plays an important role in managing symptoms. Doctors may recommend that patients pace their activities, rest when needed, and avoid situations that worsen shortness of breath. Some patients benefit from supplemental oxygen if their breathing is significantly affected. Nutritional support, including ensuring adequate intake of vitamins like B12 and folate (even though deficiencies in these vitamins are not the primary cause), helps optimize the body’s ability to produce blood cells when it can.^[6]

Innovative Treatments Being Studied in Research Trials

Scientists around the world are working to develop new treatments for anaemia of chronic disease by targeting the specific biological processes that go wrong when chronic illness affects blood cell production. Much of this research focuses on a molecule called hepcidin, which plays a central role in regulating iron metabolism. In anaemia of chronic disease, inflammation causes the liver to produce too much hepcidin. This excess hepcidin blocks the absorption of iron from food in the intestines and traps iron inside cells called macrophages, preventing the body from using its iron stores to make new red blood cells.^[6]

One promising area of clinical research involves developing medications that block hepcidin or reduce its production. These are often called hepcidin inhibitors or anti-hepcidin antibodies. By preventing hepcidin from doing its job, these experimental drugs aim to release the trapped iron, making it available for red blood cell production even while inflammation continues. Early-phase clinical trials (Phase I and Phase II) have tested several of these compounds to determine if they are safe and whether they can effectively mobilize iron and improve anaemia without causing harmful side effects.^[6]

Another research approach targets the inflammatory signals themselves. Since inflammation is the root cause of the abnormal hepcidin production and impaired red blood cell production, medications that dampen inflammatory responses could potentially treat the anaemia at its source. Some clinical trials are investigating whether existing anti-inflammatory medications, or new ones being developed, can reduce anaemia of chronic disease by lowering levels of inflammatory molecules called cytokines. These include interleukin-6, tumor necrosis factor-alpha, and interleukin-1, which are proteins that immune cells release during inflammation and that interfere with normal blood cell production.^[5]

Researchers are also exploring improved versions of erythropoiesis-stimulating agents. Next-generation ESAs are being designed to work longer in the body, requiring less frequent injections, or to work better in patients whose bone marrow has become resistant to standard ESAs due to ongoing inflammation. Some experimental ESAs are combined with other molecules that help overcome the effects of inflammation on the bone marrow, potentially making them more effective for anaemia of chronic disease specifically.^[9]

In addition to medications, some clinical trials are testing new formulations of iron that might work better in patients with anaemia of chronic disease. Researchers are investigating whether certain types of intravenous iron preparations can bypass the hepcidin block more effectively than others, allowing iron to reach the bone marrow even when inflammation is present. These studies typically involve patients with inflammatory bowel disease or chronic kidney disease who have both anaemia of chronic disease and true iron deficiency, a combination that makes treatment particularly challenging.^[9]

Clinical trials testing these various approaches are conducted in multiple phases. Phase I trials focus on safety, enrolling small numbers of volunteers to determine whether a new drug causes unacceptable side effects and to identify the appropriate dose. Phase II trials enroll more patients (typically dozens to a few hundred) to gather preliminary information about whether the treatment improves anaemia and to continue monitoring for side effects. Phase III trials are large studies, often involving hundreds or thousands of patients, that compare the new treatment directly against the current standard treatment to determine if the new approach is better, worse, or equivalent.^[9]

Some early-phase clinical trials have reported encouraging preliminary results. For example, studies of certain hepcidin-blocking antibodies have shown that they can increase blood iron levels and reduce the need for transfusions in some patients, though these findings need confirmation in larger trials. Other research has found that adding anti-inflammatory treatments to standard care can modestly improve anaemia in patients with conditions like rheumatoid arthritis, though the effect size and whether it meaningfully improves quality of life remain under investigation.^[6]

Clinical trials for anaemia of chronic disease are conducted in many locations around the world, including the United States, Europe, and other regions. The specific eligibility requirements vary by trial but generally include having a confirmed diagnosis of anaemia of chronic disease, meeting certain blood count criteria, and having a specific underlying condition that the trial is studying. Some trials focus on patients with cancer, others on those with kidney disease or inflammatory conditions, and some enroll patients regardless of the underlying cause as long as chronic inflammation is present.^[9]

Patients interested in clinical trials can discuss options with their healthcare providers, who can help determine whether any available trials might be appropriate for their situation. Participating in research offers the possibility of accessing new treatments before they become widely available, and it contributes to advancing medical knowledge that may help future patients. However, it also involves risks, including the possibility that the experimental treatment may not work or may cause unexpected side effects.^[9]

Most common treatment methods

• Treatment of underlying disease
  • Managing the chronic illness causing inflammation, such as using anti-inflammatory medications for rheumatoid arthritis or antimicrobial treatments for chronic infections
  • Controlling cancer or chronic kidney disease with disease-specific therapies
  • This approach often allows anaemia to improve naturally as inflammation decreases
• Erythropoiesis-stimulating agents (ESAs)
  • Medications like epoetin alfa and darbepoetin alfa that mimic natural erythropoietin
  • Given as injections under the skin or into a vein, typically once or twice weekly
  • Help stimulate the bone marrow to produce more red blood cells
  • Particularly useful in anaemia from chronic kidney disease or cancer
  • Require monitoring for side effects including high blood pressure, blood clots, and cardiovascular complications
• Blood transfusions
  • Provide immediate relief by supplying donated red blood cells through an intravenous line
  • Reserved for severe cases causing dangerous symptoms like chest pain or severe shortness of breath
  • Used when hemoglobin levels drop to very low levels or when rapid correction is needed
• Iron supplementation
  • Only used when blood tests confirm true iron deficiency exists alongside anaemia of chronic disease
  • May include oral iron tablets or intravenous iron infusions
  • Not routinely given because inflammation traps iron, making it unavailable even when stores are normal
  • Taking unnecessary iron can be dangerous and cause organ damage
• Supportive care
  • Activity pacing and adequate rest to manage fatigue
  • Supplemental oxygen for patients with significant breathing difficulties
  • Nutritional support including adequate vitamins B12 and folate
  • Regular monitoring through blood tests and medical follow-up