Anemia of chronic disorder is characterized by –
**Anemia of Chronic Disease**
**Core Concept**
Anemia of chronic disease (ACD) is a type of anemia that occurs in patients with chronic infections, inflammatory disorders, or malignancies. It is characterized by a complex interplay between the bone marrow, kidney, and liver, leading to impaired iron utilization and erythropoiesis.
**Why the Correct Answer is Right**
In ACD, the production of hepcidin, a hormone produced by the liver, is increased in response to inflammatory cytokines. Hepcidin binds to ferroportin, the only known iron exporter, causing its internalization and degradation. This leads to a decrease in iron availability for erythropoiesis, resulting in anemia. Furthermore, the chronic inflammation also leads to an increase in the production of soluble transferrin receptor (sTfR), which is a marker of iron deficiency.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because ACD is not primarily characterized by a deficiency in iron absorption. While iron absorption is impaired, the main issue is the increased hepcidin levels leading to iron sequestration within the reticuloendothelial system.
* **Option B:** This option is incorrect because ACD is not typically associated with a significant decrease in the production of erythropoietin (EPO). In fact, EPO levels may be elevated in response to the anemia, but the bone marrow's response to EPO is impaired due to the inflammatory environment.
* **Option C:** This option is incorrect because ACD is not primarily a result of a defect in the bone marrow's ability to produce red blood cells. The bone marrow's response to EPO is impaired, but the primary issue lies in the impaired iron utilization and availability.
**Clinical Pearl / High-Yield Fact**
In patients with ACD, the serum iron levels may be normal or elevated, but the total iron-binding capacity (TIBC) is decreased, and the transferrin saturation is increased. This can make it challenging to diagnose ACD based on serum iron levels alone.
**Correct Answer: C. Impaired iron utilization due to increased hepcidin levels.**