Anemia of chronic disease (ACD): The Daily PANCE Blueprint
A 56-year-old with long-standing rheumatoid arthritis presents with fatigue. Labs show microcytosis, normal serum iron, ↑Ferritin, ↓TIBC, and suspected ↑Hepcidin activity. Hemoglobin electrophoresis is normal. Which anemia is most likely?
A. Iron deficiency anemia
B. Thalassemia
C. Anemia of chronic disease
D. Sideroblastic anemia
E. Lead poisoning
Answer and topic summary
The answer is Anemia of chronic disease
Chronic inflammation → IL-6–mediated hepcidin elevation, which blocks ferroportin, traps iron in macrophages, decreases gut iron absorption, and lowers TIBC. This produces functional iron deficiency despite normal iron stores, with ↑Ferritin being a key clue.
- Iron deficiency anemia – Classically ↓Ferritin, ↑TIBC, ↓Iron; not seen here.
- Thalassemia – Microcytosis out of proportion to anemia; iron studies usually normal.
- Sideroblastic anemia – ↑Serum iron, ↑Ferritin, and ring sideroblasts on marrow.
- Lead poisoning – Neuropathy, GI pain, basophilic stippling, typically ↑Free erythrocyte protoporphyrin.
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Covered under ⇒ PANCE Blueprint Hematology ⇒ ⇒ ⇒
