The Use of Recombinant Human Erythropoietin in the Treatment of the Anemia of Chronic Disorders

Abstract

Common infectious diseases as well as numerous noninfectious disorders such as rheumatoid arthritis, Hodgkin’s disease, and metastatic carcinomas are associated with a similar type of anemia. As defined by Cartwright in his classic 1966 review [5]: “The anaemia is usually mild in the degree and not progressive in severity and is characterized by a low plasma iron, decreased total iron binding capacity, decreased saturation of transferrin with iron, decreased bone marrow sideroblasts, normal or increased reticuloendothelial iron, increased plasma copper and increased free erythrocyte protoporphyrin.” Being roughly proportional to the severity of the underlying disease, hemoglobin (Hb) concentrations usually range from 7.0 to 11.0 g/dl [5,14]. A variety of names have been proposed for this anemia, but since etiology and pathogenesis are still far from being clarified the most commonly used name is anemia of chronic disorders (ACD). ACD is thought to be a common feature in the broad spectrum of infections and inflammatory diseases [8]. There is in the literature, however, surprisingly little in the way of controlled data about its incidence. In an analysis conducted at the Rheumatology Unit of the University Hospital of Frankfurt, we calculated an incidence of 7.3% for ACD in a population of 218 patients with various rheumatic diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and mixed connective tissue disease (MCT; Fig. 1).