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Expression of the Iron Hormone Hepcidin Distinguishes Different Types of Anemia in African Children

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Science Translational Medicine  07 May 2014:
Vol. 6, Issue 235, pp. 235re3
DOI: 10.1126/scitranslmed.3008249

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Hepcidin Guides Iron Supplementation in African Children

Anemia affects 300 million preschool children worldwide and has multiple causes including iron deficiency or infection. Dietary iron supplementation is used to combat anemia, but substantial concerns exist that iron can be harmful, in part by promoting infection. Iron is likely to preferentially benefit children with iron deficiency anemia, but identification of such children is challenging. Hepcidin is the hormone that regulates body iron levels and inhibits absorption of iron from the diet. Hepcidin concentrations are generally low in iron deficiency but are raised in iron-replete individuals and are also increased by infection. In a new study, Pasricha et al. set out to investigate whether hepcidin measurements would enable targeting of interventions to children who need iron but who are also able to absorb it. They tested this by measuring hepcidin in three cohorts of preschool African children from The Gambia and Tanzania. Single cutoffs of hepcidin concentrations efficiently identified children with iron deficiency, distinguished between iron deficiency anemia and anemia due to infection and inflammation, and predicted which children would incorporate >20% of an oral iron dose into their red blood cells. Thus, hepcidin is a critical determinant of iron homeostasis and may be a useful marker to guide diagnosis of anemia and enable screen-and-treat iron supplementation programs.

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