Anemia of Inflammation vs. Iron-Deficiency Anemia: Diagnostic Challenges and Overlapping Mechanisms

Anemia of inflammation (AI) and iron-deficiency anemia (IDA) are two common causes of anemia that frequently pose diagnostic challenges due to their overlapping clinical and laboratory features. AI, often associated with chronic infections, autoimmune disorders, and malignancies, is primarily driven by the dysregulation of iron homeostasis and inflammatory cytokines, particularly hepcidin. IDA, on the other hand, results from inadequate dietary intake, malabsorption, or chronic blood loss, leading to depleted iron stores. Distinguishing between AI and IDA is critical for effective management but remains complex due to shared laboratory findings, such as low serum iron levels and microcytic hypochromic anemia. This review explores the pathophysiology of AI and IDA, their overlapping mechanisms, and the key diagnostic markers that differentiate them. We also discuss emerging biomarkers, such as soluble transferrin receptor (sTfR) and hepcidin, and the role of therapeutic strategies, including iron supplementation and anti-inflammatory interventions. Improved diagnostic approaches are essential for guiding targeted treatment strategies and optimizing patient outcomes. Keywords: Anemia of inflammation, Iron-deficiency anemia, Hepcidin, Soluble transferrin receptor, Microcytic anemia, Iron metabolism, Diagnostic biomarkers