A 62-year-old man presents with fatigue and a hemoglobin of 8 g/dL. Peripheral smear shows hypochromic microcytic red cells. Serum ferritin is 400 ng/mL, serum iron 30 mcg/dL, TIBC 200 mcg/dL (low), and transferrin saturation 15%. Bone marrow iron stains show abundant macrophage iron. Which cytokine-driven mediator best explains these findings?

• A Transferrin receptor upregulation causing iron sequestration in enterocytes
• B Erythropoietin excess, which depletes marrow iron stores
• C Hepcidin, which blocks ferroportin and traps iron in macrophages ✓
• D Hemosiderin deposition secondary to repeated transfusion

Explanation

Anemia of chronic disease shows low serum iron, low TIBC, high ferritin, and adequate marrow macrophage iron. Inflammation raises hepcidin from the liver, which binds ferroportin on enterocytes and macrophages, internalizing it and preventing iron release into plasma. True iron deficiency would show absent marrow iron and a high TIBC, which kills option D as well.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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