Iron deficiency anemia vs Anemia of chronic disease
How to tell Iron deficiency anemia and Anemia of chronic disease apart when a board question makes them look alike.
Iron deficiency: low ferritin with high TIBC; anemia of chronic disease: high or normal ferritin with low TIBC.
Side by side
Microcytic anemia with low ferritin, high TIBC, pica, or chronic blood loss.
Anemia in chronic inflammation with low iron availability, normal-high ferritin, and low TIBC.
True iron depletion limits hemoglobin synthesis.
Inflammation increases hepcidin, trapping iron in storage and reducing absorption.
Iron deficiency: ferritin under 30 ng/mL (or under 100 in inflammation), high TIBC, high soluble transferrin receptor, transferrin saturation under 16 percent, sTfR-F index above 2, and a peripheral smear with hypochromic microcytic cells and pencil cells.
Anemia of chronic disease: high-or-normal ferritin, low TIBC, normal soluble transferrin receptor, transferrin saturation typically 10 to 20 percent, normal-to-mildly low MCV, and an underlying inflammatory, malignant, or chronic infectious driver.
The trap
Both can be microcytic with low serum iron, so MCV and serum iron alone cannot split them. Ferritin is the high-yield tiebreaker, but ferritin is an acute-phase reactant that rises with inflammation, infection, and malignancy. In an inflamed patient, a normal ferritin under 100 ng/mL with transferrin saturation under 20 percent reopens iron deficiency; a soluble transferrin receptor to log-ferritin index (sTfR-F) above 2 confirms it.
Watch it explained
The repair move
Do not stop at serum iron. Use ferritin, TIBC, and soluble transferrin receptor to decide empty versus locked stores.
Try a free question
CoreA patient with chronic colon blood loss has microcytic anemia, low ferritin, low serum iron, and high TIBC. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Iron deficiency anemia. Low ferritin and high TIBC indicate depleted iron stores.
Why the other choices are tempting
- B. Anemia of chronic disease has normal/high ferritin and low TIBC.
- C. Thalassemia has globin-chain defects and often normal iron studies.
- D. Sideroblastic anemia has iron trapped in mitochondria with ring sideroblasts.
- E. Lead poisoning causes basophilic stippling and neurologic/GI findings.
Flashcards
Tap a card to flip it.
What is the fastest separator for Iron deficiency anemia vs Anemia of chronic disease?
Iron deficiency: low ferritin with high TIBC; anemia of chronic disease: high or normal ferritin with low TIBC.
What clue should make you choose Iron deficiency anemia?
Microcytic anemia with low ferritin, high TIBC, pica, or chronic blood loss.
Quick answers
What is the fastest way to tell Iron deficiency anemia from Anemia of chronic disease?
Iron deficiency: low ferritin with high TIBC; anemia of chronic disease: high or normal ferritin with low TIBC.
What is the key clue for Iron deficiency anemia?
Microcytic anemia with low ferritin, high TIBC, pica, or chronic blood loss.
What is the key clue for Anemia of chronic disease?
Anemia in chronic inflammation with low iron availability, normal-high ferritin, and low TIBC.
What is the common trap with Iron deficiency anemia vs Anemia of chronic disease?
Both can be microcytic with low serum iron, so MCV and serum iron alone cannot split them. Ferritin is the high-yield tiebreaker, but ferritin is an acute-phase reactant that rises with inflammation, infection, and malignancy. In an inflamed patient, a normal ferritin under 100 ng/mL with transferrin saturation under 20 percent reopens iron deficiency; a soluble transferrin receptor to log-ferritin index (sTfR-F) above 2 confirms it.