A 65-year-old man with rheumatoid arthritis presents with anemia (Hb 9.5 g/dL, MCV 78 fL). Serum iron is low. Which additional laboratory pattern most strongly supports anemia of chronic disease rather than iron deficiency anemia?

• A TIBC elevated, serum ferritin low, soluble transferrin receptor elevated
• B TIBC elevated, serum ferritin elevated, soluble transferrin receptor normal
• C TIBC low, serum ferritin elevated, soluble transferrin receptor normal ✓
• D TIBC low, serum ferritin low, soluble transferrin receptor elevated

Explanation

Anemia of chronic disease shows low serum iron with low TIBC (hepcidin traps iron in macrophages), normal or elevated ferritin (acute phase reactant), and normal soluble transferrin receptor (no increased erythropoietic drive). Iron deficiency shows elevated TIBC, low ferritin, and elevated soluble transferrin receptor. Mixed patterns suggest combined deficiency.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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