Characterization of acquired anemia in children by iron metabolism parameters

Yael Ben-David,Carina Levin,Raul Colodner,Ariel Koren

doi:10.1038/s41598-022-06574-0

Yael Ben-David, Carina Levin + Show 2 more

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https://doi.org/10.1038/s41598-022-06574-0

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Abstract

Inflammatory states are associated with anemia of chronic disease and acute infection. Hepcidin, a regulator of iron metabolism, is involved in iron pathophysiology during inflammation. We investigated biochemical characteristics in children with anemia from different causes. Four patient groups (n = 38; mean age: 12.44 ± 4.35 years) were studied: (1) inflammatory bowel disease (IBD, 10 patients); (2) iron deficiency anemia (IDA, 12); (3) celiac disease (CD, 8); (4) acute infection (AI, 8). Laboratory measurements were evaluated at diagnosis: blood count, serum iron, transferrin, ferritin, vitamin B12, folic acid, CRP, erythropoietin, hepcidin and soluble transferrin receptor (sTfR). IDA patients had the lowest Hgb (6.9 ± 1.7 g/dL), MCV (63.2 ± 7.2 fL), iron (16.8 ± 13.5 µg/dL), ferritin (4.5 ± 4.5 ng/mL) and hepcidin (3.1 ± 0.8 ng/mL) values, and the highest transferrin and sTfR values. AI patients had the highest ferritin (156.2 ± 124.5 ng/mL), CRP (144.6 ± 94 mg/L) and hepcidin (74.67 ± 12.3 ng/ml) values. Overall, hepcidin levels correlated with CRP and with ferritin (r = 0.83 and 0.85, respectively). Elucidating specific etiology-related biochemical profiles in pediatric patients with anemia from different causes using a combination of laboratory biomarkers, including hepcidin, can help physicians treat the anemia.

Highlights

IntroductionDiagnosis of iron deficiency anemia (IDA) relies on measurements of serum iron (SI), transferrin, transferrin saturation and ferritin in subjects with microcytic/hypochromic anemia
Mean corpuscle volume (MCV), mean corpuscle hemoglobin (MCH) and mean corpuscle hemoglobin concentration (MCHC) were significantly lower and RDW was significantly higher in the iron deficiency anemia (IDA) group compared to the other groups (p = 0.004, 0.001, 0.001 and < 0.001, respectively; Table 2)
The combination of routine laboratory biomarkers with specific analyses, including hepcidin, EPO and soluble transferrin receptors (sTfR), can help physicians elucidate the pathophysiology, diagnose, and treat children with anemia caused by different etiologies

Summary

Introduction

Diagnosis of iron deficiency anemia (IDA) relies on measurements of serum iron (SI), transferrin, transferrin saturation and ferritin in subjects with microcytic/hypochromic anemia Hepcidin levels in those patients are low, and soluble transferrin receptors (sTfR) are high. ACD is primarily a disorder of iron d istribution5 Inflammatory mediators such as IL-6 and IL-2 raise hepcidin levels; these, in turn, lower iron availability when there is no real iron deficiency. Inflammatory mediators such as IL-6 and IL-2 raise hepcidin levels; these, in turn, lower iron availability when there is no real iron deficiency6 In these patients, laboratory findings are suggestive of, but not specific for ID. Anemia in CD is considered IDA because of iron malabsorption, and laboratory findings are usually consistent with ID, which means low SI and ferritin, and high transferrin levels. We further define and differentiate laboratory biomarkers in four groups of children with newly diagnosed anemia due to different causes: inflammatory bowel disease (IBD), IDA, CD and anemia in AI, to better understand the pathophysiology of anemia in those patients toward providing the appropriate treatment

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