In anemia of chronic inflammation (anemia of chronic disease), which sequence best describes the central mechanism?

• A Interleukin-6 suppresses erythropoietin production, causing marrow hypoplasia
• B Autoantibodies against transferrin receptor impair iron uptake by erythroid cells
• C Chronic blood loss depletes iron stores faster than the gut can absorb
• D Tumor necrosis factor increases hepcidin release, blocking iron export through ferroportin ✓

Explanation

Pro-inflammatory cytokines, chiefly interleukin-6 acting through the JAK-STAT pathway, induce hepatic hepcidin synthesis. Hepcidin binds ferroportin on enterocytes and macrophages, triggering its internalization and degradation, so absorbed iron stays locked inside cells. The result is low serum iron with high ferritin and low transferrin (low TIBC), the profile that separates it from iron deficiency, where TIBC is high.

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

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