Review Question - QID 104675

This patient most likely has anemia of chronic disease (ACD). Particularly, if erythropoeitin (EPO) is to be administered, it is necessary to confirm that iron stores are adequate as giving EPO will cause a surge in production of red blood cells (RBCs) - without sufficient iron the RBC production can trigger an iron deficient state.

Anemia of chronic disease, also known as anemia of chronic inflammation, is characterized by decreased RBC production due to impaired iron utilization. In inflammatory states, the liver produces increased amounts of hepcidin, which prevents release of iron stores by internalisation of ferroportin molecules from the cellular membrane. Thus this patient cannot effectively manufacture RBCs and presents with (1) decreased serum iron, (2) low TIBC with low-to-normal transferrin saturation, and (3) increased ferritin. The presence of normal amounts of stored iron confirms the diagnosis.

Incorrect Answers:
Answer 2: EPO is a common treatment for ACD but only after confirming replete iron stores.

Answer 3: While colon cancer may cause anemia in adults, the best next step would be iron studies.

Answers 4-5: These management steps would not be appropriate in the management of this patient.