Which of the following diseases leads to high total iron-binding capacity?

High total iron-binding capacity (TIBC) is typically associated with iron deficiency anemia. In this condition, the body has insufficient iron available for hemoglobin synthesis, leading to an increase in transferrin production, the protein responsible for transporting iron in the blood. When there is low serum iron, the liver increases the production of transferrin to maximize iron absorption from the diet and to facilitate the transport of available iron to erythroid tissue for hemoglobin synthesis. As a result, the total iron-binding capacity, which reflects the levels of transferrin, rises.

In the other conditions, such as hemochromatosis, ineffective erythropoiesis, and chronic kidney disease, the TIBC would generally be lower due to different mechanisms involving iron overload or reduced red blood cell production which does not stimulate transferrin synthesis like iron deficiency does. In chronic kidney disease, for example, there are alterations in erythropoiesis and often systemic iron overload, leading to a different iron profile that does not typically present with elevated TIBC.