In anemia of chronic disease, which combination of iron studies is typical?

• A. Decreased serum iron, increased ferritin, decreased TIBC
• B. Increased serum iron, decreased ferritin
• C. Normal iron studies
• D. Decreased ferritin

Answer: (A)

Anemia of chronic disease is driven by inflammation that traps iron in storage and limits its availability for red blood cell production. Inflammation stimulates hepcidin, which blocks ferroportin and prevents iron from leaving iron stores and entering the bloodstream. This lowers serum iron even though stores are sufficient or elevated. Ferritin rises or stays normal because it is an acute-phase reactant and reflects iron stores; the inflammatory state also pushes ferritin up. At the same time, transferrin production decreases during inflammation, reducing the total iron-binding capacity. So the typical iron studies show decreased serum iron, increased ferritin, and decreased TIBC. The other patterns don’t fit: high serum iron isn’t seen in inflammatory sequestration; normal iron studies miss the inflammatory pattern; low ferritin points to iron deficiency rather than anemia of inflammation.