Dr. S.0 MIKAYE / LinkedIn
May 5, 2026, 10:58
Samwel Mikaye: Understanding the Distinction Between Iron Deficiency Anemia and Anemia of Chronic Disease
Samwel Mikaye, Medical Doctor at MSK, shared a post on LinkedIn:
“Iron deficiency anemia
Definition
Anemia caused by true depletion of body iron stores, leading to reduced hemoglobin synthesis.
Causes:
- Chronic blood loss (most common)
- Menorrhagia
- GI bleeding (ulcer, malignancy)
- Poor dietary intake
- Malabsorption (e.g., celiac disease)
- Increased demand (pregnancy, growth)
Pathophysiology:
Reduced iron stores leads to reduced hemoglobin, which causes microcytic, hypochromic RBCs.
Clinical Features:
- Fatigue, weakness
- Pallor
- Pica (ice/clay craving)
- Koilonychia (spoon nails)
- Glossitis, angular cheilitis
Lab Findings:
- Reduced Hb
- Reduced MCV
- Reduced ferritin (KEY finding)
- Increased TIBC
- Reduced transferrin saturation
Management:
- Treat cause (e.g., GI bleed workup)
- Oral iron (ferrous sulfate)
- IV iron if needed
Anemia of chronic disease
Definition:
Anemia caused by chronic inflammation/infection/malignancy leading to impaired iron utilization.
Causes:
- Chronic infections (e.g., TB)
- Autoimmune disease (RA, SLE)
- Chronic kidney disease
- Malignancy
Pathophysiology (key idea):
Inflammation upregulates hepcidin, which leads to iron trapped in macrophages
So iron is present but not usable.
Clinical Features:
- Symptoms of underlying chronic disease
- Mild anemia (usually less severe than iron deficiency)
Lab Findings:
- Reduced or normal serum iron
- Normal or increased ferritin (iron stored but trapped)
- Reduced TIBC
- Normal or slightly reduced MCV (can be normocytic or mildly microcytic)
Management:
- Treat underlying disease
- Erythropoietin (especially in CKD)
- Iron therapy usually not effective alone.”
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