title: Serum hepcidin as a diagnostic test of iron deficiency in premenopausal female blood donors.
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.
  
  
  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.
authors.affiliation: Australian Red Cross Blood Service, Melbourne, VIC, Australia.
authors.forename: Sant-Rayn
authors.initials: SR
authors.lastname: Pasricha
authors.forename: Zoe
authors.initials: Z
authors.lastname: McQuilten
authors.forename: Mark
authors.initials: M
authors.lastname: Westerman
authors.forename: Anthony
authors.initials: A
authors.lastname: Keller
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Nemeth
authors.forename: Tomas
authors.initials: T
authors.lastname: Ganz
authors.forename: Erica
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D001774:Blood Chemical Analysis; D001782:Blood Donors; D003677:Deficiency Diseases / Q000175:diagnosis; D005260:Female; D064451:Hepcidins; D006801:Humans; D000090463:Iron Deficiencies; D017697:Premenopause; D012016:Reference Values; D012680:Sensitivity and Specificity
chemical_list: D023181:Antimicrobial Cationic Peptides; C578702:HAMP protein, human; D064451:Hepcidins