Haematologica, Vol 93, Issue 6, e51 doi:10.3324/haematol.12814
Copyright © 2008 by Ferrata Storti Foundation
Comment to: Hepcidin: from discovery to differential diagnosis. Haematologica 2008; 93:90-7
K. Sigvard Olsson1,
Anders Norrby1
1 Section of Hematology, Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
2 Capio Lundby Hospital, Göteborg, Sweden
In your journal there is a review article on hepcidin1 summarizing the rapid (r)evolution of new knowledge in the field of iron metabolism gained during the last decade. New molecular actors along the iron pathways are presented in elegant figures easily available for teaching purposes by a little click on the computer.
Figure 1 reproduced from a previous review2 is such a figure, illustrating the iron content of the tissues involved in the daily iron traffic. The erythrocytes have 1800 mg, bone marrow 300 mg, macrophages 600 mg, the figures for the major storage site, the liver, is not given. The numbers seem to be taken from a previous review article in N Engl J Med by Nancy Andrews.3 We wonder about the health of this person with more iron in his iron stores (1900 mg) than in the blood, 1800 mg. As one gram of haemoglobin contains 3,4 mg of iron, 1800 mg corresponds to 529 gram of haemoglobin. Let us assume that he has a total blood volume of 5,5 L as that found in normal Swedish men.4,5 With a correction figure of 0.91 for the body/venous hematocrit ratio his hemoglobin will be 529/5.5 x 0,91=105,7 g/L.
He is anemic!
We previously performed vigorous phlebotomy studies to measure the iron stores in normal men. In one study4 of 11 normal men the iron stores measured 757±333 mg in another of 19 men5 486±253 mg. None had a value exceeding 1400 mg of iron.
Thus the person presented in the reviews with anemia and elevated iron storage seems to suffer from anemia of chronic disease rather than being a healthy person.
Even if the focus of the reviews is to present new molecular events the reader should also be given correct information concerning more basal findings.
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References
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- Kemna EH, Tjalsma H, Willems HL, Swinkels DW. Hepcidin: from discovery to differential diagnosis. Haematologica 2008;93:90-7.[Abstract/Free Full Text]
- Swinkels DW, Janssen MC, Bergmans J, Marx JJ. Hereditary hemochromatosis: genetic complexity and new diagnostic approaches. Clin Chem 2006;52:950-68.[Abstract/Free Full Text]
- Andrews NC. Disorders of iron metabolism. N Engl J Med 1999;341:1986-95.[Free Full Text]
- Olsson KS. Iron stores in normal men and male blood donors. As measured by desferrioxamine and quantitative phlebotomy. Acta Med Scand 1972;192:401-7.[ISI][Medline]
- Norrby A. Iron absorption studies in iron deficiency. Scand J Haematol Suppl 1974;20:1-125.[Medline]
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