Hepcidin in tumor-related iron deficiency anemia and tumor-related anemia of chronic disease: pathogenic mechanisms and diagnosis

Abstract

Objectives: Anemia is a common hematological abnormality in patients with cancer. Iron deficiency anemia (IDA) and anemia of chronic disease (ACD) are the most prevalent, both characterized by hypochromic microcytic anemia and low serum iron (SI). Their differential diagnosis is difficult in clinical practice, hampering their treatment. Our objective was to evaluate the use of hepcidin to discriminate tumor-related IDA and ACD and to investigate the mechanism of action of hepcidin in these anemias.

Methods: Blood samples were collected at Jiangsu Cancer Hospital. Patients were divided into IDA and ACD groups by Prussian blue staining of bone marrow smears. Serum hepcidin was measured by enzyme-linked immunosorbent assay. SI, total iron-binding capacity (TIBC), transferrin saturation (TSAT), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α) also determined in this study.

Results: Areas under the curve on receiver operating characteristic analysis indicated the diagnostic sensitivity and specificity of hepcidin to be better than those of SI, TIBC, and TSAT. In ACD, hepcidin was correlated positively with IL-6 (r = 0.81, P < 0.01) and negatively with SI (r = -0.78, P < 0.01). In IDA, no significant relationship between IL-6 and hepcidin was found (r = -0.20, P = 0.17), but hepcidin decreased with decreasing quartiles of SI (r = 0.89, P < 0.01). SI was positively correlated with hemoglobin (r = 0.89, P < 0.01; r = 0.84, P < 0.01) in both groups.

Conclusions: Hepcidin is a promising serological marker for the differential diagnosis of tumor-related ACD and IDA, clarifying the pathogenesis of these anemias and guiding corrective treatment.

Keywords: anemia; anemia of chronic disease; hepcidin; iron; iron deficiency anemia; tumor.