<prompt> Subnormal Ferritin is seen in all, except:Iron deficinecy anemiaAnaemia of chronic diseaseLiver diseaseHypothyroidism  <response>: B Anaemia of chronic disease Patients with chronic inflammatory or neoplastic disease often develop anemia of chronic disease. Cytokines produced by inflammation cause a block in the normal recirculation of iron from reticuloendothelial cells which pick up the iron from senescent red blood cells to the red cell precursors normoblasts. In addition, IL-1 and interferon y decrease the production of and the response to erythropoietin. This causes a drop in the serum iron concentration and a normocytic or mild microcytic anemia. The inflammatory reaction, however, also decreases the iron-binding capacity as opposed to iron-deficiency anemia, where the iron-binding capacity is elevated, so the saturation is usually between 10 and 20. The anemia is rarely severe Hb rarely less than 8.5 gdL. The hemoglobin and hematocrit will improve if the underlying process is treated. Diseases not associated with inflammation or neoplasia i.e., congestive heart failure, diabetes, hypertension, etc. do not cause anemia of chronic disease. Blood loss would generally cause a lower serum iron level, an elevated iron-binding capacity, and a lower iron saturation. The serum ferritin low in iron deficiency normal or high in anemia of chronic disease will usually clarify this situation. Vitamin B12 or folate deficiency are associated with a macrocytic anemia. Sideroblastic anemia can be either microcytic or macrocytic occasionally with a dimorphic population of cells: some small and some large, but is not associated with a low iron level. 