Haematology: anaemia of chronic disease: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: anaemia of chronic disease

Sample item

A 48-year-old woman with long-standing rheumatoid arthritis has haemoglobin 9.5 g/dL and MCV 78 fL. Serum iron is low, TIBC is low and ferritin is 320 ng/mL. Which mechanism accounts for the low serum iron?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. IL-6 induced hepcidin that degrades ferroportin and traps iron in macrophages

In chronic inflammation IL-6 stimulates hepatic hepcidin production. Hepcidin degrades ferroportin, so iron is retained in macrophages and enterocytes, serum iron falls and ferritin remains normal or high. Transferrin is a negative acute phase reactant, and hence TIBC is low, which contrasts with iron deficiency.

Option by option

  • A. Chronic gastrointestinal blood loss from anti-inflammatory drugs

    Blood loss would give low ferritin and a high TIBC, which does not fit these results.

  • B. IL-6 induced hepcidin that degrades ferroportin and traps iron in macrophages (correct)

    Correct. Hepcidin-mediated iron sequestration lowers serum iron while stores remain adequate.

  • C. Defective haem synthesis from ALA synthase deficiency

    ALA synthase deficiency causes X-linked sideroblastic anaemia, with high iron and ring sideroblasts.

  • D. Increased hepatic transferrin synthesis binding iron avidly

    Transferrin synthesis falls in inflammation, which explains the low TIBC rather than raising it.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, IL-6 induced hepcidin that degrades ferroportin and traps iron in macrophages. In chronic inflammation IL-6 stimulates hepatic hepcidin production.

Why is "Chronic gastrointestinal blood loss from anti-inflammatory drugs" not the answer?

Blood loss would give low ferritin and a high TIBC, which does not fit these results.

Why is "Defective haem synthesis from ALA synthase deficiency" not the answer?

ALA synthase deficiency causes X-linked sideroblastic anaemia, with high iron and ring sideroblasts.

Why is "Increased hepatic transferrin synthesis binding iron avidly" not the answer?

Transferrin synthesis falls in inflammation, which explains the low TIBC rather than raising it.

What concept does this question test?

It tests Haematology: anaemia of chronic disease in Pathology. Hepcidin degrades ferroportin, so iron is retained in macrophages and enterocytes, serum iron falls and ferritin remains normal or high. Transferrin is a negative acute phase reactant, and hence TIBC is low, which contrasts with iron deficiency.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: anaemia of chronic disease?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.