Iron indices are pivotal in tuberculosis (TB) owing to their influence on pathogens and immune reactions. Iron indices substantially affect TB progression, resulting in inflammation and anemia. Tuberculosis can induce iron deficiency or excess that may result in compromised immunological function. This study examined the iron index hemoglobin (Hb), serum iron, ferritin, total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC), and transferrin saturation (TSAT) in PTB patients. Between January 2016 and December 2018, the Port Sudan Tuberculosis Diagnostic Center studied a cohort of 100 adult patients definitively diagnosed with PTB. Additionally, 100 healthy individuals of similar age and sex were chosen as controls for comparative analysis. Among the 100 PTB patients studied, 90% (90/100) had anemia, with an odds ratio of 0.923 (95% CI 0.82-1.04). Anemia of chronic disease (ACD) was the most prevalent type (37%, 31/90). The patients showed diminished levels of HB, serum iron, TIBC, and TSAT compared to the controls, except for ferritin levels. UIBC was higher in patients than in controls, but this difference was not statistically significant. The research concludes that iron metabolism is modified during tuberculosis infection. Consequently, anemia in PTB patients is primarily attributed to ACD rather than iron shortage. The indices of serum iron, TIBC, and UIBC were ineffective in distinguishing between the forms of anemia in PTB patients, as their levels fluctuated in response to the infection. Ferritin served as superior metric for distinguishing between anemia of chronic disease and iron deficiency anemia.