In anemia of chronic disease (anemia of inflammation), which mediator directly blocks iron release from macrophages and suppresses gut absorption, producing the characteristic low-serum-iron, low-TIBC picture?

• A Erythropoietin
• B Interleukin-6 acting on erythroid precursors
• C Hepcidin ✓
• D Tumor necrosis factor suppressing ferroportin indirectly

Explanation

Hepcidin, produced by the liver under IL-6 drive, binds ferroportin on enterocytes and macrophages and triggers its internalization, trapping iron in stores. This explains both the low serum iron and the low transferrin/TIBC that distinguish it from iron deficiency, where TIBC is high. IL-6 is upstream of hepcidin, not the direct blocker of release. Erythropoietin levels are inappropriately low for the degree of anemia but are not the iron-trapping mechanism.

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

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Written and medically reviewed by the StethoPrep medical team.