A 39-year-old man has experienced chronic fatigue and weight loss for the past 3 months. There are no remarkable findings on physical examination. Laboratory studies show hemoglobin, 10.0 g/dL; hematocrit, 30.3%; MCV, 91 mm3; platelet count, 240,000/ mm3; WBC count, 7550/ mm3; serum iron 80 mg/dL; total iron-binding capacity, 145 mg/dL; and serum ferritin, 565 ng/mL. Serum erythropoietin levels are low for the level of Hb and hepcidin levels are elevated. Which of the following is the most likely diagnosis?
The increased ferritin concentration and reduced total iron-binding capacity are typical of anemia of chronic diseases, such as an autoimmune disease. Increased levels of cytokines such as interleukin-6 lead to increased hepatic production of hepcidin that stops ferroportin from releasing storage iron, promoting sequestration of storage iron, with poor use for erythropoiesis. The secretion of erythropoietin by the kidney is impaired. Various underlying diseases, including cancer, collagen vascular diseases, and chronic infections, can produce this pattern of anemia. An iron deficiency would produce microcytic anemia, with a low serum ferritin level and reduced hepcidin production. Aplastic anemia is unlikely because the platelet count and WBC count are normal. Megaloblastic anemias are macrocytic without an increase in iron stores. Microangiopathic hemolytic anemias are caused by serious acute conditions such as disseminated intravascular coagulation; these patients have thrombocytopenia caused by widespread thrombosis. Thalassemia minor is uncommon and is not associated with a positive ANA test result.
Anemia of chronic disease
Aplastic anemia
Iron deficiency anemia
Megaloblastic anemia
Blood