Serum hepcidin, iron metabolism and infection parameters in children with anemia of inflammation and with iron deficiency anemia

Abstract

Objective: Hepcidin is a key regulator of iron homeostasis. Increased hepcidin concentrations cause iron sequestration in enterocytes and macrophages. The role of hepcidin in children with iron-deficiency anemia and anemia of inflammation is unclear. In this study, we aimed to evaluate the use of serum hepcidin level as an index for iron deficiency and inflammation anemia in pediatric population. Furthermore, hepcidin is also known to be an acute-phase reactant induced by interleukin-6 (IL-6) during infection. Therefore, we investigated the relationships between hepcidin and inflammatory markers. Methods: This study included 50 children with anemia (13 with iron deficiency and 37 with inflammation) and 17 age-and gender-matched healthy children (control group). Parameters related to iron metabolism (ferritin, serum iron and total iron binding capacity), infection (Creactive protein, white blood cell count and neutrophil percentage) and hepcidin levels were measured. Results: Serum hepcidin levels in patients with anemia of inflammation (362.63±132.27 ng/ mL) were significantly higher than in patients with iron-deficiency anemia (234.10±93.59 ng/ mL) and healthy controls (220.44±49.52 ng/mL) (p=0.002, p<0.001, respectively). Serum hepcidin levels were positively correlated with ferritin (r=0.246, p=0.045), leucocytes (r=0.259, p=0.034) and CRP (r=0.426, p<0.001) levels in all children. Conclusion: This study suggested that hepcidin may have the potential advantage of being able to distinguish between anemia of inflammation and iron-deficiency anemia. In addition, serum hepcidin levels are significantly correlated with acute phase reactants and can be more useful marker than CRP which decreases quickly after the onset of an infection. Key Words: Anemia, ferritin, hepcidin, infection, inflammation, iron deficiency Conflict of Interest: Authors have no conflict of interest. ÖZETAmaç: Hepsidin demir metabolizmasının düzenlenmesinde anahtar rol oynar ve enterositlerde ve makrofajlarda demirin sekestrasyonuna yol açar. Demir eksikliği ve inflamasyon anemisi olan çocuklarda hepsidinin rolü açık değildir. Bu çalışmada serum hepsidin düzeylerinin demir eksikliği ve inflamasyon anemisinde bir belirleyici olarak kullanımı pediyatrik popülasyonda çalışıldı. Ayrıca hepsidinin infeksiyonlarda interlökin-6 (IL-6) tarafından indüklenen bir akut faz reaktanı olduğu bilinir. Bu nedenle serum hepsidin düzeyleri ile inflamatuar markerlar arasındaki ilişkiyi araştırdık. Metod: Bu çalışmaya 50 anemili (37'si inflamasyon, 13'ü demir eksikliği) çocuk ve onlarla benzer yaş grubunda ve cinsiyette 17 sağlıklı çocuk (kontrol grubu) alındı. Serum hepsidin düzeyleri, demir metabolizması ile ilgili olarak ferritin, demir ve demir bağlama kapasitesi parametreleri ve infeksiyon belirteçleri olarak da CRP, lökosit sayısı ve nötrofil oranları belirlendi. Bulgular: Serum hepsidin düzeyleri inflamasyon anemili grupta (362,63±132,27 ng/mL) demir eksikliği anemisi (234,10±93,59 ng/mL) ve sağlıklı kontrol grubundan (220,44±49,52 ng/mL) anlamlı ...

Changes in Hemoglobin Level and Mean Corpuscular Volume During the Convalescent Phase of Acute Febrile Illness in Children: A Study of the Possible Role of Hemolysis

“…Hepcidin expression is controlled by iron and inflammation, peaking at approximately 6 h after inflammation. In states of inflammation, high hepcidin levels block iron release from enterocytes and decrease iron availability (8,(29)(30)(31)(32).…”