Iron Deficiency Anemia vs Anemia of Chronic Disease
Iron Deficiency Anemia and Anemia of Chronic Disease are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Iron Deficiency Anemia vs Anemia of Chronic Disease at a glance
- Iron Deficiency Anemia: Microcytic hypochromic anemia from depleted iron stores — most common anemia worldwide.
- Anemia of Chronic Disease: Normocytic (sometimes microcytic) anemia driven by hepcidin-mediated iron sequestration in chronic inflammation.
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Side-by-side comparison
| Feature | Iron Deficiency Anemia | Anemia of Chronic Disease |
|---|---|---|
| At a glance | Microcytic hypochromic anemia from depleted iron stores — most common anemia worldwide. | Normocytic (sometimes microcytic) anemia driven by hepcidin-mediated iron sequestration in chronic inflammation. |
| Classic presentation | Pica with ice craving plus microcytic anemia and low ferritin is highly suggestive of iron deficiency.; Fatigue, dyspnea on exertion, exercise intolerance, lightheadedness; Headache, poor concentration, irritability; Pica (craving ice/pagophagia, clay, starch) — relatively specific for iron deficiency; Restless legs syndrome; Hair loss,… | Mild normocytic anemia (Hb 9-11) with low serum iron, low TIBC, and normal or elevated ferritin in a patient with chronic inflammation.; Often asymptomatic or symptoms attributed to the underlying disease; Fatigue, reduced exercise tolerance, dyspnea on exertion; Worsening of preexisting angina or heart failure; Pallor, tachycardia;… |
| Workup / key labs | Microcytic anemia (Hb low, MCV <80 fL) plus ferritin <30 ng/mL OR transferrin saturation <20% with consistent clinical context.; CBC with peripheral smear — microcytic (MCV <80), hypochromic, anisocytosis (elevated RDW), pencil cells, target cells; Iron studies — low ferritin (<30 ng/mL diagnostic in most adults; <100 ng/mL may indicate… | Mild-to-moderate anemia + identifiable chronic inflammatory state + low serum iron + low TIBC + normal/elevated ferritin.; CBC — Hb usually 8-11 g/dL; MCV normal (sometimes mildly low); Iron studies — low serum iron, low TIBC, transferrin saturation 10-20%, ferritin normal or elevated (>100 ng/mL); Reticulocyte count low (inadequate… |
| Imaging | Upper and lower endoscopy in men and postmenopausal women with IDA, and in premenopausal women not responding to iron; Capsule endoscopy if EGD/colonoscopy nondiagnostic and bleeding persists | Driven by suspected underlying condition; no specific imaging for ACD itself |
| First-line treatment | Identify and correct the underlying cause (most important step); Oral iron — ferrous sulfate 325 mg (65 mg elemental), ferrous gluconate, ferrous fumarate; one tablet every other day improves absorption and tolerability versus daily dosing; Take on empty stomach with vitamin C (orange juice) to enhance absorption; avoid concurrent… | Treat the underlying disease — most effective intervention; Optimize comorbidities (HF, diabetes, CKD); Iron repletion only if concurrent iron deficiency documented (combined picture). Prefer IV iron in CKD and IBD due to oral absorption impairment from hepcidin |
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