So by this episode, you may be coming just a little bit more comfortable with inflammatory

anemia. And again, it's important to rule out the other stuff. So you've got to be sure that

there's not an iron deficiency state, but we'll get back to that a little bit. Of course,

you want to rule out things like B-12 deficiency, folate deficiency, hemolytic anemia.

You want to be pretty sure you're not dealing with a bone marrow disease process or an

aplastic anemia and obviously not a genetic anemia like a sickle cell disease.

And that all being said, I think the challenge comes back to, it can be really difficult, at

least for me, to know if sometimes there's a combination of an iron deficiency anemia with

an inflammatory anemia. This is particularly true in inflammatory conditions where there is blood

loss. So inflammatory bowel diseases, for instance,

and others. I mean, back in the days before my time, bone marrow was used as a standard for

diagnosing iron deficiency. So if you lacked iron in the bone marrow, that showed you did not

have adequate iron stores. But we don't go to that

for iron deficiency anemia, and we rarely go to it in inflammatory anemia diagnosis. It's invasive,

it hurts, it can be subject to misinterpretation with the wrong pathologist, and I can't even imagine the cost of trying to

diagnose inflammatory anemia with a bunch of bone barrels because we're talking about a lot,

a lot of people that have this very common problem. So what labs can we look at? Well,

I already mentioned in the last episode, serum ferritin.

If it's very high, there is an inflammatory state.

Now, that does not rule out iron deficiency anemia.

But the corollary to that is when you have a very low ferretin,

and I would go back to my iron deficiency anemia lectures,

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