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

In anemia of chronic disease, the primary physiological mechanism involves the decreased production of red blood cells. This condition is typically associated with chronic infections, inflammatory disorders, or malignancies that lead to an increase in pro-inflammatory cytokines. These cytokines can disrupt the normal erythropoiesis process in the bone marrow, reducing the production of erythropoietin, a hormone essential for red blood cell development.

Additionally, the sequestration of iron due to increased hepcidin levels is a significant factor. Although iron may be present in the body, its availability for red blood cell production is impaired. The overall result is a decrease in the number of red blood cells produced, which contributes to the development of anemia.

This mechanism is distinct from accelerated destruction of red blood cells, hemoglobin destruction, or increased iron absorption, which are not characteristic features of anemia of chronic disease.