Q. Are anemia of chronic disease and iron deficiency anemia technically both iron-deficient conditions? Is it just that pure iron deficiency is caused by no iron, whereas anemia of chronic disease is more complicated? I don’t get what we’re supposed to get out of comparing the TIBC and ferritin level in these two anemias.
A. Yes – both iron deficiency anemia and anemia of chronic disease are technically iron deficiencies (if you equate “iron deficiency” with a low serum iron). IDA is a plain old iron deficiency – that’s the only problem. Everything else would work just fine – it’s just that the supply of iron is low.
In ACD, however, there’s a ton of stuff going on (and I don’t think we really completely understand everything yet either). The iron seems to be absorbed okay, for the most part, but it can’t get from the storage forms (ferritin, hemosiderin) to the red cells. Hepcidin is a major mediator of the process as we discussed here and here.
So with the lab tests, we’re just trying to distinguish between the two diseases (because at times they can look similar morphologically). Both have a low serum iron, so that doesn’t help you. In ACD, the ferritin is high, whereas in IDA, the ferritin is low (unless the patient has some other condition that makes ferritin go up – like systemic inflammation or something). If the ferritin is low, you can be sure it’s IDA. If it’s normal or high, it could be either IDA (with some other condition going on as well) or ACD.
The TIBC is high in IDA (which makes sense – there’s little iron around, so the capacity for binding iron increases). The TIBC is normal or decreased in ACD, for reasons that aren’t entirely clear. It may be that the production of transferrin goes down in ACD, which would make the TIBC stay normal (or decrease).
Tagsacute leukemia acute lymphoblastic leukemia acute myeloid leukemia acute promyelocytic leukemia Add new tag anemia b cells blood smear bone marrow brain tumors carcinoma cases chronic myelofibrosis chronic myeloid leukemia chronic myeloproliferative disorders coagulation cortisol cytochemistry cytogenetics essential thrombocythemia heart hemophilia immunology infection inflammation kaplan kidney laboratory tests lymphocyte lymphocytes lymphoma macrophages neoplasia neutrophil normal photoblog polycythemia vera red blood cells red cells sickle cell anemia skin squamous cell carcinoma stains student questions t cells
- Abhinav said A very remarkable hippocratic way of remembering nephrotic- O shit syndrome.!!! Keep it up
- Paul Gualtieri said The one email I always look forward to reading. Love it! Thank you
- Jack said Thank you, Kristine. Your words have put me at ease even though I plan to follow up with periodic b...
- maram said thanks for the review
- Temesgen dejene said Hey u ar so good…just moment before amso confused betwen two terms but now am so well diffrenc...
- Artem said Thank you so much. It is super high-yield for me.
- Gowri said Fast refresh about a normal one.. excellent
- Mohini Jayant Dave said I usually first write down what I have to say and then makes slides of valid points which I may forg...
- Chimezie Okwuonu said Good explanation. Quite clear. Am impressed
- aamir hasnain said thanx very clear and concise
- Dr. Abdul Karim Affouni said Super thanx for such friendly informative description.
- PASCUAL OC said MUCHAS GRACIAS, TODO SEA EN PRO DE LA CIENCIA!