A known case of Crohn's disease presented with worsening fatigue over the last 2 months. The 50 year old lady was on Infliximab for the past 2 years and did not have many relapses. Lab findings revealed, Hemoglobin - 8 gm/dl Low serum iron Low serum ferritin Increased TIBC Low transferrin saturation The peripheral blood smear and the hemoglobin electrophoresis is given below. Which of the following is the most likely cause of the above condition: -

This is a case of iron deficiency anemia in the setting of the Crohn's disease. 1st image shows microcytic hypochromic anemia. 2nd image shows a Normal HPLC pattern of hemoglobin, hence ruling out thalassemia. The iron studies differentiate the following types of anemia. Feature Iron deficiency anemia Anemia of chronic disease Sideroblastic anemia Serum iron Low Normal or decreased Normal to high Serum ferritin Low Normal or increased Normal to high TIBC Increased Below normal Normal %tage transferrin saturation Low Below normal Normal to increased Type of anemia Microcytic hypochromic Normocytic normochromic Microcytic hypochromic