United States Medical Licensing Examination (USMLE) Step 3 Practice Exam

In anemia of chronic disease, the body’s iron stores are typically normal or increased, which is reflected in elevated ferritin levels. This condition often arises in response to chronic inflammation or disease states, where the body sequesters iron to limit its availability to pathogens and to alter erythropoiesis.

Ferritin is an intracellular protein that stores iron, and its levels can rise as a response to inflammatory cytokines. In chronic conditions, such as infections, autoimmune diseases, or malignancies, acute-phase reactants like ferritin can increase, even when the total iron available for erythropoiesis is actually reduced due to impaired mobilization.

Thus, in anemia of chronic disease, while patients may exhibit normocytic anemia due to the underlying condition, ferritin levels generally remain high or at least are not decreased, as the body retains the iron but does not utilize it effectively for red blood cell production. This is a key distinguishing feature from other forms of anemia, such as iron deficiency anemia, where ferritin levels are decreased.