Manna Sukdev, Chakrabarti Sankha Shubhra, Singh Rohit, Gambhir Indrajeet Singh
Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Current affiliation: Department of Rheumatology and Clinical Immunology, All India Institute of Medical Sciences Kalyani, West Bengal, India.
J Family Med Prim Care. 2025 Jan;14(1):356-362. doi: 10.4103/jfmpc.jfmpc_34_24. Epub 2025 Jan 13.
The bone marrow iron study is the gold standard for differentiation of the two most common causes of anemia i.e. iron deficiency anemia (IDA) and anemia of chronic disease (ACD) in the elderly. However, it is often not feasible to do bone marrow examination (BME) in every elderly anemic patient, due to its invasive nature. Hepcidin, a liver-derived peptide, has been identified as the key systemic regulator of iron homeostasis. Our study highlights the potential diagnostic role of serum hepcidin in the evaluation of anemia in elderly.
Hundred elderly patients (≥60 years of age) having iron deficiency anemia (IDA) or anemia of chronic disease/inflammation (ACD) were the study subjects with 15 age-matched healthy controls. All patients were evaluated with history, clinical examination, routine investigations (complete blood count, liver, and kidney function tests), iron profile, and serum hepcidin. The bone marrow iron study was done in every patient to categorize them as IDA and ACD.
Serum iron, TIBC, MCV, ferritin, and serum transferrin saturation values were differing significantly between IDA and ACD groups. Serum hepcidin levels can be used confidently to differentiate ACD from IDA ( value <0.001). At serum concentration, 198.82 ng/mL sensitivity of hepcidin to differentiate ACD from IDA was 93.9% and specificity was 92.2%. A subset of patients is misdiagnosed when the serum hepcidin level is used as a sole marker, and this also holds true for serum ferritin.
Though serum hepcidin level correlates well with serum iron profile and also serum hepcidin appears to be a useful marker to differentiate ACD from IDA in terms of both sensitivity and specificity, the combined assessment of serum hepcidin and iron profile appears to be a better marker than ferritin and hepcidin alone. This could replace the use of bone marrow iron staining as a diagnostic tool in anemia in elderly.
骨髓铁研究是区分老年人贫血两种最常见病因，即缺铁性贫血（IDA）和慢性病贫血（ACD）的金标准。然而，由于其具有侵入性，对每位老年贫血患者进行骨髓检查（BME）往往不可行。铁调素是一种肝脏衍生肽，已被确定为铁稳态的关键全身调节因子。我们的研究强调了血清铁调素在评估老年人贫血中的潜在诊断作用。
一百名患有缺铁性贫血（IDA）或慢性病/炎症性贫血（ACD）的老年患者（≥60岁）作为研究对象，并选取15名年龄匹配的健康对照。所有患者均通过病史、临床检查、常规检查（全血细胞计数、肝肾功能检查）、铁代谢指标和血清铁调素进行评估。对每位患者进行骨髓铁研究，以将他们分类为IDA和ACD。
IDA组和ACD组之间的血清铁、总铁结合力、平均红细胞体积、铁蛋白和血清转铁蛋白饱和度值存在显著差异。血清铁调素水平可可靠地用于区分ACD和IDA（P值<0.001）。在血清浓度为198.82 ng/mL时，铁调素区分ACD和IDA的敏感性为93.9%，特异性为92.2%。当血清铁调素水平用作唯一标志物时，有一部分患者会被误诊，血清铁蛋白也是如此。
虽然血清铁调素水平与血清铁代谢指标密切相关，并且血清铁调素在敏感性和特异性方面似乎都是区分ACD和IDA的有用标志物，但血清铁调素和铁代谢指标的联合评估似乎比单独的铁蛋白和铁调素是更好的标志物。这可以取代骨髓铁染色作为老年人贫血诊断工具的使用。
