Anemia of chronic disease is the more frequent type of anemia seen in patients with chronic idiopathic neutropenia of adults

This study describes the frequency and the type of anemia seen in patients with nonimmune chronic idiopathic neutropenia of adults (NI-CINA). We found that NI-CINA patients had low hemoglobin levels and increased serum concen trations of erythropoietin (EPO), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1-beta (IL-1 beta). The hemoglobin levels correlated positi vely with the number of circulating neutrophils and inversely with the leve ls of EPO and TNF-alpha but not of IL-1 beta. Anemia, defined as the reduct ion of the hemoglobin below 12.0 g/dl for women and 13.3 g/dl for men, was found in 23 out of 148 patients studied, a proportion of 15.5%. Two of the anemic patients had iron deficiency anemia (8.7%), 11 had anemia of chronic disease (ACD; 47.8%) presenting with normal or slightly reduced erythrocyt ic indices, low serum iron, and increased serum ferritin, and the remaining ten had anemia of undefined pathogenesis (AUP; 43.5%) with normal or sligh tly decreased erythrocytic indices, serum iron ranging from 43 to 88 mug/dl , and ferritin values ranging from 12 to 50 ng/ml. We conclude that ACD is the more frequent type of anemia seen in patients with NI-CINA, and that pr o-inflammatory cytokines, notably TNF-alpha, may be involved in the pathoge nesis of both ACD and AUP, given that serum levels of the cytokine were sig nificantly increased and that the EPO response to anemia was blunted in the se patients. These findings further support our previously reported suggest ion for the possible existence, in NI-CINA patients, of an unrecognized low -grade chronic inflammatory process that may be involved in the pathogenesi s of the disorder.