What is the primary pathophysiological mechanism behind anemia of chronic disease?

The primary pathophysiological mechanism behind anemia of chronic disease is defective erythropoiesis. In anemia of chronic disease, inflammatory cytokines released during chronic illnesses inhibit the production and responsiveness of erythropoietin, a hormone that stimulates red blood cell production in the bone marrow. Additionally, chronic inflammatory states can alter iron metabolism by sequestering iron stores, making it less available for hemoglobin synthesis without directly causing blood loss or impairing iron absorption from the gastrointestinal tract. This impaired production of red blood cells leads to a decreased overall number of erythrocytes and contributes to the anemia observed in these patients. Thus, the central factor is the dysfunction in the bone marrow’s ability to produce adequate red blood cells in response to erythropoietin, resulting in anemia.