Anemia of chronic disease (ACD): The Daily PANCE Blueprint
Which lab value helps distinguish anemia of chronic disease from iron deficiency anemia?
A. Serum ferritin
B. Total iron-binding capacity
C. Serum iron
D. Hemoglobin
E. Mean corpuscular volume
Answer and topic summary
The answer is A. Serum ferritin
Serum ferritin is the key laboratory test that distinguishes anemia of chronic disease (ACD) from iron deficiency anemia (IDA). In ACD, ferritin is normal or elevated because it is an acute phase reactant, reflecting adequate or increased iron stores despite limited availability for erythropoiesis. In contrast, IDA shows low ferritin, indicating depleted iron stores. This distinction is critical because while both conditions can present with low serum iron, the body’s iron storage status, as measured by ferritin, provides crucial diagnostic clarity.
- Total iron-binding capacity: TIBC is decreased in anemia of chronic disease but increased in iron deficiency anemia; however, it is less specific than ferritin for distinguishing the two.
- Serum iron: Serum iron is reduced in both anemia of chronic disease and iron deficiency anemia, making it a poor differentiator.
- Hemoglobin: Hemoglobin is decreased in both conditions but does not help differentiate between types of anemia.
- Mean corpuscular volume: MCV can be low in both conditions (microcytic anemia) or even normal in anemia of chronic disease, thus not reliable alone for differentiation.
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