The only management the patient requires at this time is observation. He has inflammatory anemia (previously anemia of chronic disease), which does not usually require treatment. Chronic infections such as tuberculosis or osteomyelitis, malignancies, and collagen vascular diseases are associated with anemia. In response to inflammatory states, erythropoietin production is inhibited and the erythroid precursor response to erythropoietin is blunted. Inflammation leads to increased levels of inflammatory cytokines, including tumor necrosis factor-α, interleukin (IL)-6, IL-1, and interferon, which lead to altered erythropoietin responsiveness. In particular, IL-6 causes hepatic synthesis of the small peptide hepcidin, which is pivotal in regulating iron absorption. Hepcidin causes decreased iron absorption from the gastrointestinal tract and decreased iron release by macrophages by inducing internalization and proteolysis of the transporter protein ferroportin. No laboratory test is commercially available for measuring hepcidin levels. A peripheral blood smear may be normal in patients with inflammatory anemia, or, over time, may show microcytic hypochromic erythrocytes such as in iron deficiency. Typically, inflammatory anemia is characterized by a hemoglobin level greater than 8 g/dL (80 g/L). Because of erythrocyte underproduction, the reticulocyte count is typically low for the degree of anemia. The serum iron level is initially normal but decreases over time, the total iron-binding capacity is low, and the ferritin level is typically elevated.

Although bone marrow evaluation is seldom necessary, ample stainable iron would be present. However, it is not indicated for diagnosis in classic cases of inflammatory anemia.

Erythropoiesis-stimulating agents may improve inflammatory anemia but are associated with thrombosis and other effects that impede safe use.

Iron replacement is unlikely to alleviate the patient's symptoms, because he is not iron deficient. Iron deficiency would present with a low ferritin level of less than 100 ng/mL (100 µg/L) even in the setting of chronic inflammation. Additionally, total iron-binding capacity in iron deficiency tends to be elevated and not decreased. However, the transferrin saturation is normal in inflammatory anemia.