The potential usefulness of Hepcidin as a biomarker in patients presenting with iron deficiency anaemia (IDA)

Abstract

Anaemia is a global health concern affecting billions of people worldwide. In developing countries the predominance of nutritional iron deficiency significantly contributes to the problem of anaemia and this is indicated in the high prevalence of iron deficiency anaemia in the general population. Despite being a major problem, treatment of iron deficiency anaemia is not costly and can be administered with relative ease. The diagnosis of iron deficiency anaemia however, requires a multidisciplinary approach within the medical laboratory sections consequently resulting in the generation of a multitude of test results. The diagnostic approach to iron deficiency anaemia can be streamlined in an attempt to increase diagnostic sensitivity and to reduce uncertainties in interpreting laboratory generated data thus, the main aim of this study was to establish the usefulness of Hepcidin in the diagnosis and prognosis of iron deficiency anaemia. The other aim was to establish Hepcidin reference normal range values in Namibia for use in this study.In establishing the reference normal range, a total of forty healthy adult participants were randomly selected from eligible blood donors. Forty-five participants with iron deficiency anaemia were also randomly selected to characterise the quantitative behaviour of Hepcidin in iron deplete states. More participants with iron deficiency were recruited compared to the number for healthy participants in order to cater for sample attrition. After accounting for sample attrition, a total of forty participants with iron deficiency who were on treatment were tested.The introduction of Hepcidin testing in a routine diagnostic laboratory has potential in improving the diagnosis and prognosis of iron deficiency anaemia. In this study, serum Hepcidin reference normal range values for adults were established to be17.803-86.181ng/mL among blood donors in Namibia. Participants with features suggestive of iron deficiency anaemia had suppressed serum Hepcidin values when compared to the established reference normal range. The serum Hepcidin concentrations however increased to normal levels on following up iron deficient participants who had been on iron treatment. The dynamics of Hepcidin was consistent with levels of serum iron in the same group indicating the potential usefulness of Hepcidin in assessing iron bioavailability in iron deficiency anaemia. Correlation analysis indicated moderate but better associations between haemoglobin and Hepcidin compared to haemoglobin and serum iron levels. Anaemia had a better effect on serum Hepcidin (r=0.112) than serum iron (r=0.015) strengthening the case for using Hepcidin. Multiple regression analysis of the iron deficiency anaemia group before and after iron treatment showed statistically significant positive correlation between pre-treatment Hepcidin and serum iron (r= 0.456 p=0.003). Similarly, a moderate positive association between Δ Hepcidin and Δ serum iron (r= 0.319) was shown confirming the consistent association of baseline Hepcidin with serum iron.

Date of Award	31 Jan 2018
Original language	English
Awarding Institution	University of Bath
Supervisor	Gordon Taylor (Supervisor)