A 60-year-old lady with a history of rheumatoid arthritis has the following lab findings: Hb 4.5 g/dL, Platelet count 200 mg/dL, TLC 6000/mm3, serum ferritin-200 mg/L. TIBC-280 ng/L. What is the most likely diagnosis?

**Core Concept**
Rheumatoid arthritis (RA) is a chronic autoimmune disorder associated with various hematological abnormalities, including anemia of chronic disease (ACD). ACD is characterized by impaired iron utilization, leading to elevated serum ferritin levels despite low iron stores.

**Why the Correct Answer is Right**
The patient's lab findings are consistent with ACD, a common complication of chronic inflammatory diseases like RA. Elevated serum ferritin (200 mg/L) and low total iron-binding capacity (TIBC) (280 ng/L) indicate impaired iron utilization. The presence of anemia (Hb 4.5 g/dL) and thrombocytopenia (Platelet count 200 mg/dL) further supports this diagnosis. In ACD, ferritin is elevated due to the acute phase response, whereas iron stores are reduced, leading to anemia.

**Why Each Wrong Option is Incorrect**

* **Option A:** This option is not provided.
* **Option B:** This option is not provided.
* **Option C:** This option is not provided.
* **Option D:** This option is not provided.

**Clinical Pearl / High-Yield Fact**
In patients with chronic inflammatory diseases like RA, anemia of chronic disease should be suspected when serum ferritin is elevated, and TIBC is low. This diagnosis can be confirmed by a serum iron level, which is typically low in ACD.

**Correct Answer:** D. Anemia of chronic disease.

✓ Correct Answer: B. Anemia of chronic disease