Anaemia of Chronic Disease — SCE Rheumatology MCQ

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ModerateRheumatoid ArthritisAnaemia of Chronic DiseaseSCE Rheumatology

A 62-year-old man with RA on Methotrexate develops normocytic anaemia (Hb 98 g/L MCV 88 fL). His CRP is 45 mg/L ESR 62 mm/hr. Iron studies show low serum iron low transferrin saturation elevated ferritin and low total iron binding capacity. What type of anaemia is this?

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Correct answer: C — Anaemia of chronic disease (anaemia of inflammation)

The combination of normocytic anaemia with low serum iron low transferrin saturation elevated ferritin and low TIBC in the context of active inflammation (high CRP ESR) is the classic profile of anaemia of chronic disease (anaemia of inflammation). In ACD hepcidin levels are elevated (driven by IL-6) causing functional iron sequestration in macrophages and reduced iron absorption despite adequate total body iron stores (hence elevated ferritin). This contrasts with true iron deficiency where ferritin is low. Treatment targets the underlying inflammatory disease. Erythropoiesis-stimulating agents are rarely needed.

Reference: EULAR 2022 RA recommendations; Weiss G et al 2005 anaemia of chronic disease