A 62-year-old man with rheumatoid arthritis has Hb 9.8 g/dL, MCV 76 fL. Serum iron 30 µg/dL (low), TIBC 210 µg/dL (low), transferrin saturation 14%, ferritin 180 ng/mL, CRP elevated. Which is the single best interpretation?
- A Iron deficiency anemia with concurrent inflammation
- B Anemia of chronic disease ✓
- C Beta-thalassemia trait
- D Sideroblastic anemia
Correct answer: B. Anemia of chronic disease
Explanation
Low serum iron together with low TIBC and a ferritin above 100 ng/mL indicates blocked iron release rather than true deficiency, the pattern of anemia of chronic inflammation driven by hepcidin. In iron deficiency, TIBC is high and ferritin is low, so option A fails on two counts. Transferrin saturation is low in both conditions and cannot separate them; the ferritin level and TIBC are the discriminating values.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.