A 60-year-old lady with a history of rheumatoid arthritis has the following lab findings: Hb 4.5 g/dL, Platelet count 200 mg/dL, TLC 6000/mm3, serum ferritin-200 mg/L. TIBC-280 ng/L. What is the most likely diagnosis?

Ans. b. Anemia of chronic disease (Ref: Wintrobe's 12/e pe p 1221-1222)Anemia of chronic disease is associated with decreased serum iron, decreased TIBC, decreased % saturation and normal or increased serum ferritin levels.Test(normal values)IrondeficiencyThalassemiaSideroblastic anemiaAnemia of chronic diseaseSmearMicrocytichypochromicMicrocytichypochromicMicrocytichypochromicNormocytic normochromic> Micro/ hypochromicSerum iron (50-150 mg/dl)Low (<30)NormalNormal| (<50)TIBC(300-360 mg/dl)High (>360)NormalNormal| (<300)% Saturation (30-50%)<10 (|ed)N or |ed (30-80)N or | (30-80)| (10-20)Ferritin (mg/l) (50-200 mg/L)< 15 (|ed)| (50-300)| (50-300)Normal or | (30-200)Hemoglobin patternNormalAbnormalNormalNormalFree Erythrocyte Protporphrin|edNormal|ed|edRDW|edNormalNormalNormalAnemia of Chronic DiseaseCharacterized by block in delivery of ironQ from the reticuloendothelial system to the erythroid progenitors.Consequently patients have normal to increased iron stores in the marrow and normal to increase ferritin IevelQ.Because of block in delivery, serum iron levels fall and so does TIBC and transferrin saturationQ.Low serum iron with increased TIBCIron deficiency anemiaQLow serum iron with decreased TIBCAnemia of chronic diseaseQ