Subnormal Ferritin is seen in all, except:

(B) Anaemia of chronic disease > Patients with chronic inflammatory or neoplastic disease often develop anemia of chronic disease.> Cytokines produced by inflammation cause a block in the normal recirculation of iron from reticuloendothelial cells (which pick up the iron from senescent red blood cells) to the red cell precursors (normoblasts).> In addition, IL-1 and interferon y decrease the production of and the response to erythropoietin. This causes a drop in the serum iron concentration and a normocytic or mild microcytic anemia.> The inflammatory reaction, however, also decreases the iron-binding capacity (as opposed to iron-deficiency anemia, where the iron-binding capacity is elevated), so the saturation is usually between 10 and 20%. The anemia is rarely severe (Hb rarely less than 8.5 g/dL). The hemoglobin and hematocrit will improve if the underlying process is treated.> Diseases not associated with inflammation or neoplasia (i.e., congestive heart failure, diabetes, hypertension, etc.) do not cause anemia of chronic disease.> Blood loss would generally cause a lower serum iron level, an elevated iron-binding capacity, and a lower iron saturation. The serum ferritin (low in iron deficiency normal or high in anemia of chronic disease) will usually clarify this situation.> Vitamin B12 or folate deficiency are associated with a macrocytic anemia.> Sideroblastic anemia can be either microcytic or macrocytic (occasionally with a dimorphic population of cells: some small and some large), but is not associated with a low iron level.