True regarding anaemia of chronic disease are all except
**Core Concept**
Anaemia of chronic disease (ACD) is a condition characterized by a decrease in iron availability due to chronic inflammation, leading to a decrease in erythropoietin production and an increase in hepcidin levels. This results in impaired iron absorption and sequestration of iron in macrophages, ultimately causing anemia.
**Why the Correct Answer is Right**
The correct answer is related to the pathophysiology of anaemia of chronic disease. Anaemia of chronic disease is often associated with chronic infections, autoimmune disorders, or malignancies. The chronic inflammation leads to the production of pro-inflammatory cytokines, such as TNF-alpha and IL-1 beta, which stimulate the production of hepcidin. Hepcidin, in turn, inhibits the release of iron from macrophages, leading to a decrease in serum iron levels and an increase in transferrin saturation. This results in a normocytic, normochromic anemia.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because anaemia of chronic disease is not typically associated with a decrease in erythropoietin production. In fact, erythropoietin production is often increased in response to the anemia, leading to an increase in red blood cell production.
**Option B:** This option is incorrect because anaemia of chronic disease is often characterized by an increase in hepcidin levels, not a decrease. Hepcidin is a key regulator of iron metabolism and plays a critical role in the pathogenesis of anaemia of chronic disease.
**Option C:** This option is incorrect because anaemia of chronic disease is often associated with an increase in transferrin saturation, not a decrease. Transferrin saturation is a measure of the amount of iron bound to transferrin, and it is often elevated in patients with anaemia of chronic disease due to the sequestration of iron in macrophages.
**Option D:** This option is incorrect because anaemia of chronic disease is often associated with a decrease in serum iron levels, not an increase. The sequestration of iron in macrophages and the inhibition of iron release by hepcidin lead to a decrease in serum iron levels.
**Clinical Pearl / High-Yield Fact**
A key feature of anaemia of chronic disease is the presence of a "hypochromic" anemia, characterized by a decrease in the amount of hemoglobin per red blood cell. This is due to the impaired iron availability and the resulting decrease in hemoglobin synthesis.
**Correct Answer: D. An increase in serum iron levels.**