A 58-year-old woman with rheumatoid arthritis has haemoglobin 9.2 g/dL, low serum iron, low transferrin saturation, and elevated ferritin. The peptide hormone chiefly responsible for restricting iron availability in this state acts by:

• A Inhibiting ferroportin on enterocytes and macrophages, trapping iron in stores ✓
• B Upregulating divalent metal transporter 1 on the duodenal brush border
• C Blocking transferrin receptor 1 expression on erythroid precursors
• D Stimulating hepatic ceruloplasmin synthesis to oxidise ferrous iron

Explanation

This is anaemia of chronic disease driven by inflammation-induced hepcidin release from the liver. Hepcidin binds ferroportin, the sole cellular iron exporter, triggering its internalisation and degradation. This blocks iron exit from duodenal enterocytes and macrophage stores into plasma, producing low serum iron with high ferritin. Upregulating DMT1 would increase absorption, ceruloplasmin (ferroxidase) actually promotes iron loading onto transferrin, and blocking transferrin receptors is not a hepcidin action.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.