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).

10 Responses to Iron deficiency vs. anemia of chronic disease

  1. medshamsstudent says:

    i could not full understand this


    can you make it easier ????

  2. medshamsstudent says:

    thanks any way

  3. Diana says:

    thanks! it helped me a lot 🙂

  4. Antonia says:

    You are not right!!! All is entirely clear!! Thanks a lot because it really helped me! Furthermore, that more important it was very quickly.

  5. De says:

    The way I undestand it:
    When a person has inflammation from, for example, cancer, strep, or fibromyalgia, the body realizes that usually whatever is causing the inflammation, bacteria or cancer; needs iron to grow. The body tries to withhold the iron as a defence mechanism, and stores as much iron as it can into ferritin; only releasing a small amount.
    So ferritin can look normal on a blood test but, hardly any is being released, so the person is anemic. Which is how doctors often overlook anemia of inflammation…only the ferritin is looked at. Even worse, is if iron tablets are given to a patient who for example has cancer and it helps the cancer grow. Treating the inflammation is supposed to cure the anemia…if a doctor happens to discover it.
    Note’ (If the disease causing inflammation, is causing blood loss, like bleeding in the colon, the ferritin level could go down.)
    Both types of anemia have- low iron serum.
    In both types of anemia’s there are somewhat small cells present.
    In iron deficiency anemia, the transferrin (which carries iron) is up– –indicating the body needs more iron.
    In iron deficiency anemia, TIBC is higher- because of low stores in ferritin, reflecting the bodies efforts to produce more transferrin to bind up as much iron as possible.

    In chronic inflammation and disease anemia, the transferrin is low —because there is ample iron–but it’s not readily available.
    In chronic inflammation and disease anemia, TIBC is ‘usually’ low -normal —because the iron stores (ferritin) are elevated or normal.
    C-reactive Protein is helpful in telling the difference, and what kind of anemia. It may be elevated if inflammation is present.
    Left too long, a patient can get tachycardia as the heart tries to get more oxygenated blood, which can also drive BP up.
    At least, I think that’s how it all works.
    I just know I had to try to figure it out myself, gather about 8 years of lab blood work, and go ‘hit doctors over the head’ with it. pointing it out to a Cardiologist, Internal Med and GI Specialist ….and still I haven’t any answers; so do not feel bad if you don’t understand, the difference in anemia’s; apparently for the most part no one else does either either.

  6. Artem Grigoryan says:

    The answer is good. Just a comment: in ACD iron absorption is decreased (due to hepcidin or other mechanisms).

  7. Dr.Radius says:

    thanx alot I understand now where is the deference
    I face this Quistion in exame today but my answer was wrong
    I will never forget this point in rest of my life (:

  8. Kristine says:

    Oh shoot. Yeah, the wrong answers sometimes stick with us longer than the right ones…

  9. Ahmad says:

    I found the answer I was looking for. It was very helpful. Thanks a lot.

  10. Tracey says:

    Excellent explanation, thank you!

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