Author Affiliations

  1. Sant-Rayn Pasricha1,2,
  2. Zoe McQuilten1,
  3. Mark Westerman3,
  4. Anthony Keller1,
  5. Elizabeta Nemeth3,4,
  6. Tomas Ganz3,4 and
  7. Erica Wood1,2
  1. 1Australian Red Cross Blood Service, Melbourne, VIC, Australia
  2. 2Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, VIC, Australia
  3. 3Intrinsic LifeSciences LLC, La Jolla, CA, USA
  4. 4Medicine and Pathology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
  1. Correspondence: Erica Wood, Australian Red Cross Blood Service, Melbourne VIC Australia. Phone: international +61.3.96940203. Fax: international +61.3.96940108. E-mail: ewood{at}redcrossblood.org.au
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Abstract

Background Currently used indicators of iron status have limitations. Hepcidin, a key regulator of iron metabolism, is reduced in iron deficiency. We sought to determine the properties of hepcidin as a diagnostic test of iron deficiency.

Design and Methods Sera from female, non-anemic, whole blood donors were analyzed for hepcidin (enzyme-linked immunosorbent assay), ferritin, soluble transferrin receptor and C-reactive protein. Iron deficiency was defined as (i) serum ferritin less than 15 ng/mL or (ii) soluble transferrin receptor /log(ferritin) index greater than 3.2 if the C-reactive protein concentration was less than 10 mg/L, or greater than 2.2 if the C-reactive protein concentration was greater than 10 mg/L). Receiver operating characteristic curves were plotted to determine the overall utility and identify optimal cut-points of hepcidin as a test of iron deficiency.

Results In 261 blood donors the prevalence of iron deficiency defined by ferritin concentration was 59/261 [22.6% (17.5, 27.7)], whereas defined by soluble transferrin receptor/log(ferritin) index it was 53/261 [20.4% (15.4, 25.2)]. The 95% reference range of hepcidin concentration in the iron-replete population was 8.2–199.7 ng/mL. The area under the receiver operating characteristic curve for hepcidin compared with ferritin concentration less than 15 ng/mL was 0.87 (0.82, 0.92), while that compared with the soluble transferrin receptor /log(ferritin) index was 0.89 (95% CI 0.84, 0.93). For a diagnosis of iron deficiency defined by the soluble transferrin receptor/log(ferritin) index, hepcidin less than 8 ng/mL had a sensitivity of 41.5% and a specificity of 97.6%, while hepcidin less than 18 ng/mL had a sensitivity of 79.2% and a specificity of 85.6%.

Conclusions Serum hepcidin concentration may be a useful indicator of deficient iron stores. Further studies are required to evaluate the role of hepcidin in the diagnosis of iron deficiency in other groups of patients.

  • Received November 23, 2010.
  • Revision received March 15, 2011.
  • Accepted April 12, 2011.
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