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D63.8 – Anaemia in Chronic Disease
D63.8 is the ICD-10 code for anaemia in other chronic diseases classified elsewhere. It refers to a form of anaemia that develops as a consequence of an underlying chronic condition.
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D63.8 is the ICD-10 code for anaemia in other chronic diseases classified elsewhere. It refers to a form of anaemia that develops as a consequence of an underlying chronic condition.
What is D63.8?
The ICD-10 code D63.8 stands for anaemia in other chronic diseases classified elsewhere. This refers to a form of anaemia (low red blood cell count or low haemoglobin) that is not primarily caused by iron deficiency or bleeding, but rather develops as a direct consequence of a long-standing chronic underlying condition. This type of anaemia is also commonly known as anaemia of chronic disease (ACD) or anaemia of inflammation.
Causes
D63.8 occurs across a broad range of chronic conditions that are not captured under other specific ICD codes for anaemia in chronic diseases. Common underlying conditions include:
- Chronic infectious diseases (e.g., tuberculosis, chronic urinary tract infections)
- Chronic inflammatory conditions (e.g., rheumatoid arthritis, systemic lupus erythematosus)
- Malignant tumours (cancers, where not coded elsewhere)
- Chronic liver and kidney disease (when not separately coded)
- Endocrine disorders such as hypothyroidism or diabetes mellitus
The anaemia arises from a complex interplay of impaired iron utilisation, shortened red blood cell lifespan, and reduced production of erythropoietin (a hormone that stimulates red blood cell production).
Pathophysiology (Mechanism of Disease)
In chronic inflammation and disease, the body releases increased amounts of pro-inflammatory signalling molecules called cytokines, such as interleukin-6 (IL-6). These stimulate the liver to produce more hepcidin, a protein that regulates iron metabolism. Elevated hepcidin levels block the release of iron from storage cells and inhibit iron absorption in the intestine. As a result, less iron is available to the bone marrow for new red blood cell production, even though the body's total iron stores may be normal or even elevated.
Symptoms
Symptoms of anaemia in chronic disease are often non-specific and may overlap with those of the underlying condition. Common symptoms include:
- Persistent fatigue and exhaustion
- Pallor of the skin and mucous membranes
- Shortness of breath during physical activity
- Dizziness and difficulty concentrating
- Increased heart rate (tachycardia)
- General decline in physical performance
Diagnosis
Diagnosis of anaemia of chronic disease (D63.8) involves several steps:
- Full blood count (FBC): Reveals a reduced haemoglobin (Hb) level, typically normocytic or mildly microcytic red blood cells.
- Iron metabolism parameters: Low serum iron, low transferrin saturation, normal or elevated ferritin (iron storage protein).
- Inflammatory markers: Elevated CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate).
- Reticulocyte count: Usually normal or low, indicating an inadequate bone marrow response.
- Exclusion of other causes: Vitamin B12 and folate deficiencies, bleeding sources, and haematological disorders must be ruled out.
Treatment
The most important step in managing D63.8 is treating the underlying chronic condition. In many cases, improving the primary disease leads to improvement of the anaemia as well. Additional treatment options include:
- Iron supplementation: Only recommended when a concurrent iron deficiency has been confirmed; can be given orally or intravenously (by infusion).
- Erythropoiesis-stimulating agents (ESAs): In selected cases, such as chronic kidney disease or cancer-related anaemia, erythropoietin preparations may be used.
- Blood transfusions: As a short-term measure for severe, symptomatic anaemia.
- Nutritional optimisation: Ensuring adequate dietary intake of iron, vitamin B12, and folate.
References
- Weiss G, Goodnough LT. Anemia of Chronic Disease. New England Journal of Medicine. 2005;352(10):1011-1023.
- World Health Organization (WHO). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. WHO Press, Geneva, 2011.
- Kasper DL et al. Harrison's Principles of Internal Medicine. 21st edition. McGraw-Hill Education, 2022.
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