An analysis of the use of hepcidin as a marker of iron status in anaemia

Jacob, Doreen Rachel
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Objectives Iron deficiency is a major cause of anaemia and differentiation from anaemia of chronic disease (ACD) can be a challenge. Iron deficiency anaemia (IDA) is a particular worry in the blood donor population. Hepcidin has been postulated as a marker capable of making the distinction. The aim of this study was to evaluate the use of hepcidin as a marker of iron status in blood donors with anaemia. Methods Serum hepcidin concentrations, measured using a hybrid micro-liquid chromatography triple quadrupole ion trap mass spectrometer, were categorised into three groups based on associated haemoglobin and ferritin levels (IDA, ACD, and Controls), and compared for differences. Leptin, soluble transferrin receptor (sTfR), C-reactive protein and creatinine were measured. The sTfR log ferritin index was derived and also evaluated to differentiate groups. Results Hepcidin showed significant differences between the ACD group [7.89 nmol/L (5.96, 10.84)] and the other two groups while IDA [1.65 nmol/L (1.06, 2.41)] and the control group [2.62 nmol/L (1.71, 3.84)] concentrations were found to overlap. Cut-offs of ≤2.88 nmol/L (AUCROC of 0.826) and >4.87 nmol/L (AUCROC of 0.93) for IDA and ACD, respectively, were derived from ROC curves. A sTfR log ferritin index of >3.04 was derived but was not found to be superior to ferritin concentrations in IDA. Conclusion Hepcidin measured using mass spectrometry shows benefit as a marker to differentiate blood donors with ACD from those with IDA.
A research report submitted in fulfilment of the requirements for the degree of Master of Science in Medicine (Chemical Pathology) to the Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, 2022