The informativity of the markers of iron metabolism in the differential diagnosis of anemia of inflammation in children with chronic HBV infection

Abstract

Objective: To assess diagnostic importance of iron metabolism markers in the progression of anemia of inflammation (AI) in children with chronic HBV infection.Materials and methods: Among 148 examined children with chronic HBV infection 140 had AI, 60.7% of them with refractory (RA) and 39.3% with non-refractory (nRA) progression variant. Complete blood count was performed using hematologic automatic analyzer. Virologic verification of HBV was done by ELISA and PCR. ELISA was used to determine 25-hepcidin, serum iron, ferritin, trasferrin, sTfR, IL-1, IL-6. The index sTfR/log10Ft was calculated.Results: Performing the examination of children with chronic HBV infection we determined high prevalence of AI, equal to 94.6%, which was characterized by normocyte normochromic progression, thrombocytopenia, thrombocrit decrease in case of RA, and microcyte hypochromic progression with erythrocyte anisocytosis in case of nRA. Despite the high inflammatory index induced by HBV viral replication, children with RA had characteristic decrease in 25-hepcidin and transferrin parameters with background high values of ferritin, while nRA was characterized by rise of 25-hepcidin and transferrin spectrum with low values of serum iron and ferritin.Conclusions. In the genesis of AI in chronic HBV cases two pathogenic variants were determined: true iron deficiency with ferromarkers in the type of IDA characteristic for nRA and redistribution iron deficiency compliant to hemosiderosis characteristic for RA. Priority in the differential diagnosis of AI variants is given to the comparison of sTfR/log10Ft index parameters (RA<1.0; nRA>2.0) with reference level of 25-hepcidin<28,68ng/ml in case of RA, and >56,37ng/ml in case of nRA.