title: Low hepcidin levels in severely anemic malawian children with high incidence of infectious diseases and bone marrow iron deficiency.
abstract: BACKGROUND
  A reliable diagnostic biomarker of iron status is required for severely anemic children living in malarious areas because presumptive treatment with iron may increase their infection risk if they are not iron deficient. Current biomarkers are limited because they are altered by host inflammation. In this study hepcidin concentrations were assessed in severely anemic children living in a highly malarious area of Malawi and evaluated against bone marrow iron in order to determine the usefulness of hepcidin as a point of care test.
  
  
  METHODS
  207 severely anemic children were assessed for levels of hepcidin, ferritin, serum transferrin receptor, erythropoietin, hematological indices, C-reactive protein, interleukin-6, malaria parasites and HIV infection. Deficiency of bone marrow iron stores was graded and erythroblast iron incorporation estimated. Interaction of covariates was assessed by structural-equation-modeling.
  
  
  CONCLUSIONS
  Hepcidin was a poor predictor of bone marrow iron deficiency (sensitivity 66.7%; specificity 48.5%), and of iron incorporation (sensitivity 54.2%; specificity 61.8%), and therefore would have limitations as a point of care test in this category of children. As upregulation of hepcidin by inflammation and iron status was blunted by erythropoietin in this population, enhanced iron absorption through the low hepcidin values may increase infection risk. Current recommendations to treat all severely anemic children living in malarious areas with iron should therefore be reconsidered.
authors: Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
authors: Femkje A M
authors: FA
authors: Jonker
authors: Job C J
authors: JC
authors: Calis
authors: Kamija
authors: K
authors: Phiri
authors: Rob J
authors: RJ
authors: Kraaijenhagen
authors: Bernard J
authors: BJ
authors: Brabin
authors: Brian
authors: B
authors: Faragher
authors: Erwin T
authors: ET
authors: Wiegerinck
authors: Harold
authors: H
authors: Tjalsma
authors: Dorine W
authors: DW
authors: Swinkels
authors: Michael Boele
authors: MB
authors: van Hensbroek
mesh_terms: D000740:Anemia / Q000097:blood* / Q000453:epidemiology*; D001853:Bone Marrow / Q000378:metabolism*; D002675:Child, Preschool; D003141:Communicable Diseases / Q000097:blood* / Q000453:epidemiology*; D004920:Erythropoiesis; D005260:Female; D064451:Hepcidins / Q000097:blood*; D006801:Humans; D000860:Hypoxia / Q000097:blood; D015994:Incidence; D007223:Infant; D000090463:Iron Deficiencies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis
chemical_list: D064451:Hepcidins