A 58-year-old man with rheumatoid arthritis has Hb 9.8 g/dL, MCV 78 fL, serum iron 35 microgram/dL, TIBC 180 microgram/dL, transferrin saturation 19%, and ferritin 340 ng/mL. Which pattern best explains these values?

• A Anaemia of chronic disease with iron-restricted erythropoiesis despite adequate stores ✓
• B Iron deficiency anaemia with depleted stores
• C Beta thalassaemia trait with iron overload
• D Sideroblastic anaemia with mitochondrial iron loading

Explanation

Inflammation raises hepcidin, which traps iron in macrophages and blocks duodenal absorption, producing low serum iron and low TIBC with a normal or high ferritin, exactly this picture. In true iron deficiency the ferritin would be low and the TIBC high, because the liver upregulates transferrin when stores are empty. Ferritin above roughly 100 ng/mL effectively excludes iron deficiency as the sole cause here.

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

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Written and medically reviewed by the StethoPrep medical team.