Total iron-binding capacity is decreased in anemia of chronic disease.

• A. Increased
• B. Normal
• C. Variable
• D. Decreased

Answer: (D)

In anemia of chronic disease, inflammation alters iron metabolism so that iron is kept away from circulation. The inflammatory signal increases hepcidin, which traps iron in storage sites, and cytokines also suppress production of transferrin, the protein that carries iron in the blood. Since total iron-binding capacity mainly reflects how much transferrin is available, this capacity decreases. This pattern—low serum iron with low TIBC and high ferritin (an acute-phase reactant that rises with inflammation)—is characteristic of the condition. Increased TIBC occurs with iron deficiency, while normal or variable TIBC can happen in certain mixed or early scenarios, but the classic finding in anemia of chronic disease is decreased TIBC.