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