Iron deficiency anemia vs Anemia of chronic disease
How to tell Iron deficiency anemia and Anemia of chronic disease apart when a board question makes them look alike.
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Low ferritin is the single fastest discriminator favoring iron deficiency anemia.
Side by side
Microcytic anemia with low ferritin and high TIBC is most consistent with iron deficiency anemia.
Anemia with low serum iron, low TIBC, and normal or high ferritin in chronic inflammation suggests anemia of chronic disease.
Absolute iron depletion limits hemoglobin synthesis and produces microcytosis and hypochromia.
Inflammation-driven hepcidin elevation traps iron in macrophages and reduces intestinal iron absorption.
Ferritin below 30 ng/mL, transferrin saturation below 15 percent, elevated TIBC above about 400 mcg/dL, and high RDW support iron deficiency.
Ferritin often above 100 ng/mL with low serum iron, low TIBC below about 250 mcg/dL, and CRP or ESR elevation supports anemia of chronic disease.
The trap
A common trap is treating low hemoglobin empirically with iron without determining source. The resolving clue is ferritin pattern plus clinical context; adults with confirmed iron deficiency need blood loss evaluation, especially gastrointestinal causes.
The repair move
Next best step: confirm iron deficiency with ferritin and iron indices, then evaluate the bleeding source before or alongside repletion. In an older adult, arrange colonoscopy and upper endoscopy as indicated, and start oral ferrous sulfate 325 mg every other day with vitamin C if tolerated.
Try a free question
CoreA 59-year-old man has microcytic anemia with ferritin 9 ng/mL and transferrin saturation 7 percent. What is the next best step in management?
Show answer and explanation
Answer: A. Evaluate for gastrointestinal blood loss while starting iron replacement. Confirmed iron deficiency in an older adult requires source evaluation plus repletion.
Why the other choices are tempting
- B. ACD usually has normal or high ferritin and low TIBC, unlike this pattern.
- C. B12 deficiency causes macrocytosis, not classic microcytic iron deficiency indices.
- D. Deferring evaluation risks missing bleeding or malignancy.
- E. Transfusion is not first-line for stable chronic iron deficiency.
Flashcards
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Which ferritin threshold strongly supports iron deficiency anemia?
Ferritin below about 30 ng/mL in the appropriate clinical context.
Which iron-study profile points to anemia of chronic disease?
Low serum iron with low TIBC and normal to high ferritin.
Quick answers
What is the fastest way to tell Iron deficiency anemia from Anemia of chronic disease?
Low ferritin is the single fastest discriminator favoring iron deficiency anemia.
What is the key clue for Iron deficiency anemia?
Microcytic anemia with low ferritin and high TIBC is most consistent with iron deficiency anemia.
What is the key clue for Anemia of chronic disease?
Anemia with low serum iron, low TIBC, and normal or high ferritin in chronic inflammation suggests anemia of chronic disease.
What is the common trap with Iron deficiency anemia vs Anemia of chronic disease?
A common trap is treating low hemoglobin empirically with iron without determining source. The resolving clue is ferritin pattern plus clinical context; adults with confirmed iron deficiency need blood loss evaluation, especially gastrointestinal causes.