Evaluation of hepcidin as a biomarker for the differential diagnosis of iron deficiency anaemia and anaemia of chronic disease

Abstract

Background:Anaemia affects approximately 1.62 billion people globally corresponding to 24.8% of the world's population. Iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are the most common forms of anaemia. A hormone produced by the liver, hepcidin, is the primary regulator of iron homeostasis and its production increases in ACD and decreases in IDA. Usually, ACD and IDA coexist and sometimes look identical on peripheral blood smears. Aims and Objectives: The current study aims to evaluate the diagnostic value of hepcidin to predict ACD from IDA as well as the diagnostic value of hepcidin to predict ACD from a combination of IDA and ACD. Materials and Methods: Specimens presenting with haematological indices suggestive of IDA and/or ACD following World Health Organisation (WHO) standard case definitions were identified among samples coming to the Haematology laboratory for routine investigations. Serum hepcidin, serum ferritin, serum iron and total iron binding capacity (TIBC) were assessed. Demographic data was obtained from specimen requisition forms. Results: Of the 66 participants, 62.1% (n = 41) were females. IDA was more common among females (36.4%) than males (6.1%) while ACD was more common in males (19.7%) than females (12.1%). Iron Deficiency Anaemia participants had significantly lower hepcidin levels than ACD (p<0.001). There was a significant positive correlation between serum hepcidin and serum ferritin levels (p < 0.001). Conclusion: We found that IDA participants had significantly lower hepcidin levels than ACD and IDA/ACD combined. Therefore, serum hepcidin could be considered in diagnosing and distinguishing ACD from IDA or IDA/ACD as it also had high diagnostic sensitivity and specificity compared to other markers.

Role of Hepcidin in Anemia of Chronic Disease in Rheumatoid Arthritis

“…Our results revealed that in a group of anemic and nonanemic RA patients, HEP is correlated (to varying magnitudes) to markers anemia, iron metabolism, inflammation, and erythropoiesis ( Table 1 ). This is in accordance with previous studies demonstrating similar associations between HEP and anemia markers 21 22 23 24 25 or iron metabolism 25 26 27 28 29 however, others have reported no correlation. 23 30 31 32 …”

“…demonstrating similar associations between HEP and anemia markers [21][22][23][24][25] or iron metabolism [25][26][27][28][29] however, others have reported no correlation. 23,[30][31][32] In order to better understand the dynamics of this complex correlation matrix, we performed data reduction using PCA where linear combinations of the original variables were "reduced" to single factors.…”

Associations of Common Variants in HFE and TMPRSS6 Genes with Hepcidin-25 and Iron Status Parameters in Patients with End-Stage Renal Disease

“…We found excellent diagnostic properties for hepcidin-25, FRT, TSAT, and MCV for distinguishing IDA from ACD in ESRD patients. We presented the best diagnostic characteristic at 9.32 ng/mL for hepcidin-25 which is consistent with literature data [ 17 , 26 , 29 ]. Valenti et al have stated that an adequate iron balance was likely present in most patients included in the second and third hepcidin quartiles (1.56–49.8 ng/mL) [ 17 ].…”

“…Patients that have been examined in this study lacked a rare homozygous variant HFE C282Y A/A and HFE H63D G/G. Several previous studies have reported that the prevalence of the homozygosity for HFE C282Y and HFE H63D mutations is very low in Southern and Eastern Europe [ 29 , 41 – 43 ]. It is well-known that these variants are a common cause of hereditary hemochromatosis, and patients included in this study did not have this disorder.…”

“…In this study, no differences were found in the frequency distribution of gene variants of TMPRSS6 A736V, HFE H63D, HFE C282Y, and haplotypes of two HFE genes (H63D and C282Y) between genders. Some studies indicate that there is a gender-related difference in the distribution of TMPRSS6 and HFE polymorphisms in some diseases [ 29 , 44 ], but no studies have so far analyzed ESRD patients in this context. Moreover, we found higher serum levels of hepcidin-25 and FRT in males than in females in relation to HFE haplotypes.…”