Ab1068 the Role of Hepcidin in the Formation of Anemical Syndrome in Patients With Ankylosing Spondylitis and Its Significance in the Differentiation of Anemia of Chronic Disease, Iron Deficiency Anemia and Their Combination

Abstract

BackgroundAnemia is a frequent comorbid condition in ankylosing spondylitis (AS) patients. Anemia of chronic disease (ACD), iron deficiency anemia (IDA) and their combination are most often found in patients. The differential diagnosis between ACD and IDA is important because they require different treatment and at the same time is complicated due to the presence of an inflammatory component.ObjectivesTo establish the role of hepcidin in the formation of anemic syndrome in AS patients and its significance in differentiating anemia of chronic disease, iron deficiency anemia and their combination.MethodsThe study included 76 patients diagnosed with AS according to the modified New York criteria (1984) and 26 controls. Among them, there were 47 patients without anemia and 29 patients with anemia (IDA, n=7; ACD with iron deficiency, n=6; ACD, n=15, folate deficiency anemia, n=1). The diagnostic list included a complete blood count, serum iron, total iron-binding capacity, transferrin saturation, serum ferritin, soluble transferrin receptors (sTfR), and hepcidin. In the literature, there are no clear criteria for gradation of hepcidin levels, therefore, for further analysis, a percentile comparison was performed and indicators corresponding to P25 (up to 25 ng/ml), P25 - P75 (25-35 ng/ml) and P75 (above 35 ng/ml) were selected control group. The statistical processing of the obtained results was carried out using the Microsoft Office Excel 2007 statistical software package.ResultsIn the group of AS patients, 41 patients (54%) had hepcidin levels >P75, 16 (21%) - <P25, and 19 (25%) within P25 - P75. Hepcidin levels in patients with anemia were 1.4 times higher (51.77 ± 4.62 ng/ml) than in people without anemia (36.08 ± 2.57 ng/ml). The level of hepcidin (35.84±7.50 ng/ml) in patients with IDA is practically comparable to the group of patients without anemia. The level of hepcidin (62.78±5.94 ng/ml) is 1.7 times higher in people with ACD than in people with IDA (p<0.05). Patients with ACD and iron deficiency in terms of hepcidin level occupy an intermediate place (48.53±9.50 ng/ml), which may indicate an important role in the pathogenesis of ACD and can be used as a diagnostic marker for the differential diagnosis of ACD and IDA. In the group of patients without anemia, we found no significant relationship between hepcidin and indicators of red blood and ferrokinetics. While in individuals with anemia we found the relationship of hepcidin with serum iron (r=0.26; p<0.05), soluble transferrin receptors (r=-0.15; p<0.05) and transferrin saturation coefficient (r=0.17; p<0.05).ConclusionFor AS patients, for the early differential diagnosis of the types of anemia (ACD, IDA, and ACD with iron deficiency), in addition to traditional methods, the complex of laboratory tests should include determination of the hepcidin level in blood serum. A high level of hepcidin indicates the presence of ACD.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.