Iron Deficiency Anemia · Pathology

In the differential diagnosis of microcytic anemia, a high TIBC specifically points toward iron deficiency over 'Anemia of Chronic Disease' (ACD) because in ACD:

  1. TIBC is low because hepcidin suppresses transferrin
  2. TIBC is high because iron is being lost in the urine
  3. TIBC is normal because the liver is not involved
  4. TIBC is high because of chronic inflammation
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Correct answer: TIBC is low because hepcidin suppresses transferrin

Anemia of chronic disease is characterized by low serum iron but *low* TIBC and *high* ferritin. This 'iron sequestration' is driven by hepcidin, which reduces iron availability despite high storage levels, helping distinguish it from true iron deficiency.

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