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4 out of 6

A 50 yr old patient with rheumatoid arthritis presented with HB 6gm% MCV 60fl S ferritin 200 s iron 30 TIBC 280 what is the diagnosis (AIIMS Nov 2011)

A Iron deficiency anaemia

B Anaemia of chronic disease

C Thalassemia minor

D Autoimmune hemolytic anaemia

Ans. B

Anaemia of chronic disease

1. Characteristic features:

a. Occurs in the setting of chronic infections, chronic inflammation, or neoplasia.

b. The anaemia is not related to bleeding, haemolysis or marrow infiltration.

c. The anaemia is generally mild, in the range (8.5 gm% - 11 mg%), and is usually associated with a normal or increased, serum ferritin.

d. TIBC should be low or normal in anemia of chronic disease

e. Transferrin saturation is reduce or normal.

2. Pathogenesis

The inhibitory effect of various cytokines (Interleukin-1 and TNF-alpha) on erythropoiesis.

Erythropoietin levels appear to be lower than would be accepted for the degree of anemia.

Pathology of anaemia of chronic disease

Extra Edge: Pathophysiology of AOCD (Ref. Hari-18th ed., Pg. 849)

1. Interleukin 1 (IL-1) directly decreases EPO production in response to anemia. IL-1, acting through accessory cell release of interferon γ (IFN-γ), suppresses the response of the erythroid marrow to EPO—an effect that can be overcome by EPO administration in vitro and in vivo.

2. In addition, TNF, acting through the release of IFN-γ by marrow stromal cells, also suppresses the response to EPO.

3. Hepcidin, made by the liver, is increased in inflammation and acts to suppress iron absorption and iron release from storage sites. The overall result is a chronic hypoproliferative anemia.

Management – Treat the basic cause

Cause of anemia

Serum iron

Serum Ferritin










Extra Edge: AOCD & Anemia of chronic renal disease have low reticulocyte count. In AOCD, TIBC is normal or reduced, transferrin saturation is reduced.