Anaemia

Biomarker of iron metabolism has clinical and public health potential


Testing for the iron-regulating hormone hepcidin has the potential to significantly improve management of clinical conditions such as anaemia.

According to haematologist Dr Sant-Rayn Pasricha, a postdoctoral fellow at the University of Oxford’s Weatherall Institute of Molecular Medicine, the tests are close to becoming available outside research settings.

Dr Pasricha told the limbic that current iron markers each had their limitations.

“Ferritin is useful if it is low but falsely elevated by conditions such as obesity while soluble transferrin receptor is affected by erythropoiesis,” he said.

“Hepcidin, because it directly acts to regulate iron, is less about iron status and more about what the body wants to do with iron.”

Dr Pasricha said a study in female Australian blood donors had shown hepcidin was a good indicator of iron deficiency.

However it is his work in developing countries which he finds particularly informative and has important public health implications.

“We’ve recently shown hepcidin performs well as a test for iron deficiency in secondary school students in Sri Lanka even with thalassemia,” he said.

The findings suggest hepcidin screening would prevent iron-replete thalassemia carriers from receiving iron supplementation.

He said anaemia in developing countries was too often addressed by universal food fortification, iron tablets or drops.

“I question whether there is a more modern approach informed by biology – a more individual approach which will be more effective and safer.”

“Screening could reduce the need to supplement 100% of the population down to 25%. This is safer for many people as iron is thought to exacerbate the risk of malaria and other infections.”

Dr Pasricha said anaemic children in low-income populations with low levels of hepcidin should receive iron supplementation but those with high levels of hepcidin probably need their infections dealt with first.

He is now involved in a NHMRC funded randomised controlled trial of iron supplementation in children in Bangladesh.

Dr Pasricha was in Australia to present a seminar on hepcidin at the Walter and Eliza Hall Institute of Medical Research, where he will establish his own research laboratory in the Division of Population Health and Immunity from September.

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