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NBME 21 Answers

nbme21/Block 2/Question#7

A 50-year-old man with rheumatoid arthritis comes ...

Anemia of chronic disease

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submitted by dr.xx(47),

Among the most prevalent hematologic abnormalities in patients with rheumatologic disorders are the anemia of chronic disease (ACD), a mild anemia that is generally asymptomatic, and iron deficiency anemia.

In iron-deficiency anemia, the TIBC would higher than 400–450 mcg/dL because stores would be low.

Patients with RA occasionally have concurrent iron deficiency anemia and ACD. When this occurs, the hemoglobin level usually drops to below 9.5 g/dL, and the MCV is less than 80.


sympathetikey  Got the right answer too, but man, that whole "1 month after starting therapy" almost threw me off. +  

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submitted by ragacha(4),

FA 2018 page 409. Associated with inflammation (RA, SLE, CKD).

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submitted by bartolomoose(3),

This one is fairly logical if you remember that bacteria LOVE our iron. So much so, that our body came up with a way around it. When an infection is detected by the body, it makes like a doomsday prepper and batons down the hatches.

"All the iron into the bones, quick (^ferritin)! Hide it from the intruders! Get those iron delivery trucks (ferritin) off the road (blood)!

with decreased ferritin comes a decrease capacity for binding iron in the blood

cooldudeboy1  i like the way to remember acd but there is no bacterial etiology in Rheumatoid arthritis is there? +