From the Guidelines
Low iron, low iron saturation, and low total iron binding capacity (TIBC) typically indicate anemia of chronic disease (ACD), also known as anemia of inflammation. This pattern differs from iron deficiency anemia, which shows low iron, low saturation, but high TIBC, as noted in the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1. In anemia of chronic disease, the body's inflammatory response causes iron to be sequestered in storage sites, making it unavailable for red blood cell production despite adequate iron stores.
Key characteristics of anemia of chronic disease include:
- Low serum iron concentration
- Low transferrin saturation
- Low TIBC, which is less sensitive to iron deficiency than serum ferritin concentration, as changes in TIBC occur after iron stores are depleted 1
- Normal or elevated ferritin levels, which is an acute phase reactant that increases with inflammation 1
- Elevated inflammatory markers like C-reactive protein or erythrocyte sedimentation rate
This condition is commonly associated with chronic inflammatory conditions such as autoimmune disorders, chronic infections, kidney disease, or malignancies. Treatment primarily focuses on addressing the underlying condition rather than iron supplementation, as the problem isn't a lack of iron but rather its impaired utilization. Occasionally, this pattern can also represent a combined state of iron deficiency and chronic inflammation, which may require more complex management strategies including both treating the underlying condition and cautious iron supplementation.
From the Research
Anemia Pattern Indication
The anemia pattern indicated by low iron, low iron saturation, and low total iron-binding capacity (TIBC) is iron deficiency anemia.
- Low iron levels indicate a lack of sufficient iron for the production of hemoglobin, a protein in red blood cells that carries oxygen to different parts of the body.
- Low iron saturation, which is the percentage of transferrin that is saturated with iron, also points to iron deficiency anemia 2.
- Low TIBC, which measures all proteins available for binding mobile iron, including both transferrin and other proteins, is typically seen in iron deficiency anemia as well 3.
Key Characteristics
Key characteristics of iron deficiency anemia include:
- Fatigue, weakness, and shortness of breath due to a lack of red blood cells or hemoglobin in the blood.
- Pale skin, hair loss, and cold hands and feet.
- Restless legs syndrome, which is characterized by an uncontrollable urge to move the legs, usually due to uncomfortable sensations 2, 3.
Diagnosis and Treatment
Diagnosis of iron deficiency anemia is typically made through blood tests, including serum ferritin and transferrin saturation levels 2.