Friday, August 2, 2013

Difference between iron deficiency anemia and anemia of chronic disease

Hi everyone!
Sometimes simply reading doesn't help you get the difference..
So I made these notes to help you have a visual idea of the terms used while describing these diseases.

Difference between iron deficiency anemia and anemia of chronic disease
Serum ferritin is a soluble iron binding storage protein.

It’ll help you distinguish between anaemia of chronic disease (ACD) and iron deficiency anaemia (IDA). Both are microcytic!

In iron deficiency, your iron stores are decreased.
So, obviously, serum ferritin will be decreased.

In anaemia of chronic disease, liver synthesizes hepcidin.
Hepcidin is a key that locks up iron in the bone marrow and prevents it’s release to transferrin.
That’s why, ferritin is increased. (Stores are there, but unavailable!)

What is hepcidin?
It is an antimicrobial peptide secreted by the liver in response to inflammation (Acute phase reactant).
Antimicrobial? @_@
Yes, the body thinks decreasing availability of iron to microorganisms will kill em!

Note: Ferritin and transferrin are inversely related
Decreased ferritin stores increases synthesis of transferrin from the liver and vice versa.
Therefore, in iron deficiency anaemia, you’ll have an decreased ferritin and increased TIBC.
And in anaemia of chronic disease, you’ll have a increased ferritin and decreased TIBC.

PS: In IDA, the ferritin is low (Unless the patient has some other condition that makes ferritin go up – like systemic inflammation or something!)
If the ferritin is low, be sure it’s IDA.
If it’s normal or high, it could be either IDA (with some other condition going on as well) or ACD.

That's all!



  1. Please note it's wrongly typed....
    In ida there is decreased ferritin and increasef tibc.

    1. Typing mistake ^__^"
      Thank you for the correction!

  2. Replies
    1. Rapid Review Pathology, 4th Edition by Edward Goljan.

  3. Really a good account...

  4. Can i know why is it in ACD, there is decrease in TIBC. Is TIBC related to ferritin?

    1. TIBC is related to transferrin. The stuff that carries iron in blood.

      In ACD, the body doesn't want to transport iron.. It locks up iron so that it is unavailable to microorganisms.

      So even though ferritin (storage iron) is increased, transferrin is decreased during inflammation.

  5. Simple & precise explanation !
    Too good :)

  6. so simple! Thanks! One question, what is the importantce of iron to microorganisms that deprivation will kill them?

    1. This should help!


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