Anemia, Chronic Disease/Inflammation

Incidence in USA: 5%; incidence in surgical population: 5% to 75%.

Historically thought to be due to chronic infectious, inflammatory, or malignant conditions. Now known to occur with severe trauma, DM, aging, and acute immune activation.

More than 130 million Americans living with chronic diseases.

Risks related to underlying diseases

Transfusion related risks (e.g., TRALI, TACO, hemolytic reactions, immunosuppression)

Risks related to compensatory mechanisms for increasing O ₂ delivery (e.g., angina, heart failure, dysrhythmias)

Underlying diseases and their periop complications.

Impaired tissue O ₂ delivery and compensatory mechanisms aimed at correcting it.

Delayed wound healing and infection.

WHO definition of anemia: children 6 mo to 6 y: Hgb <11 g/dL; 6 to 14 y: Hgb <12 g/dL; nonpregnant females: Hgb <12 g/dL; pregnant females: Hgb <11 g/dL; males: Hgb <13 g/dL.

Usually mild with Hgb 8-11 g/dL.

Usually normochromic, normocytic with low reticulocyte count.

Low serum Fe, TIBC, and transferrin levels.

ACD/I due to disturbances of Fe homeostasis – diversion of Fe from the circulation into storage sites within the reticuloendothelial system and reduced GI absorption of Fe.

Relative Fe deficiency

Reduction in RBC production and mild decrease in RBC survival time

Certain treatments for chronic conditions