A 59-year-old man comes to the physician for a follow-up appointment. He has long-standing diabetes. Physical examination shows an S3 heart sound, lateralized apex beat, and peripheral edema. There is no jugular venous distention. Laboratory studies show:
Hemoglobin 10 g/dL
MCV 75 fL
Iron 40 μg/dL (NR 60-170)
Ferritin 290 ng/mL (NR 25-300)
Which of the following is the most likely explanation for these hematologic findings?
Cytokine-mediated erythropoietin deficiency
Decreased hepcidin
Impaired heme synthesis
Increased macrophage release of iron
Mitochondrial iron accumulation
