A 55-year-old woman with rheumatoid arthritis comes to the physician because of a 3-month history of worsening fatigue and dyspnea. She has felt short-of-breath when walking up the stairs to her apartment. Menopause occurred 5 years ago. The patient appears chronically ill and has mucosal pallor. There are thick, white plaques over the buccal mucosa and soft palate. Anterior and posterior cervical lymphadenopathy is present. The lungs are clear to auscultation. The abdomen is soft and nontender. There is no organomegaly. Laboratory results are as follows: Which of the following is the most likely underlying cause of this patient's anemia?

Question

A 55-year-old woman with rheumatoid arthritis comes to the physician because of a 3-month history of worsening fatigue and dyspnea. She has felt short-of-breath when walking up the stairs to her apartment. Menopause occurred 5 years ago. The patient appears chronically ill and has mucosal pallor.  There are thick, white plaques over the buccal mucosa and soft palate.  Anterior and posterior cervical lymphadenopathy is present.  The lungs are clear to auscultation.  The abdomen is soft and nontender.  There is no organomegaly.  Laboratory results are as follows:  Which of the following is the most likely underlying cause of this patient's anemia?

Quizplus · Accepted Answer

Eductional Objective: Anemia of chronic disease is caused by chronic elevations in inflammatory cytokines, which lead to reduced iron absorption and increased iron retention in the reticuloendothelial system.  This impairs iron availability and causes a normocytic or slightly microcytic anemia with low serum iron and low total iron-binding capacity.

A 55-Year-Old Woman with Rheumatoid Arthritis Comes to the Physician