Diagnostic potential of hepcidin and implications for management in different forms of anemia
| Condition . | Expected hepcidin levels . | Iron parameters . | Iron therapy strategies . | Potential hepcidin therapy . |
|---|---|---|---|---|
| Absolute iron deficiency anemia | Low | Low TSAT and ferritin | By mouth, or intravenous if poorly tolerated or malabsorbed | No |
| Anemia of inflammation/(AI) (iron sequestration) | High | Low TSAT, normal to elevated ferritin | Intravenous* | Antagonist |
| Mixed anemia (AI/IDA) | Normal | Low TSAT, low to normal ferritin | Intravenous† | Antagonist |
| Chronic kidney disease | High | Variable | Intravenous‡ | Antagonist |
| Resistance to ESA therapy (functional iron deficiency) | High | Low TSAT, variable ferritin | Intravenous | Antagonist |
| Iron-refractory iron deficiency anemia (IRIDA) | High | Low TSAT and ferritin | Intravenous only | Antagonist |
| Iron-loading anemias (eg, ineffective erythropoiesis) | Low | High TSAT and ferritin | Iron-chelation therapy | Agonist |
| Iron-loading anemias treated with transfusion | Normal to high | High TSAT and ferritin | Iron-chelation therapy | Agonist |
| Condition . | Expected hepcidin levels . | Iron parameters . | Iron therapy strategies . | Potential hepcidin therapy . |
|---|---|---|---|---|
| Absolute iron deficiency anemia | Low | Low TSAT and ferritin | By mouth, or intravenous if poorly tolerated or malabsorbed | No |
| Anemia of inflammation/(AI) (iron sequestration) | High | Low TSAT, normal to elevated ferritin | Intravenous* | Antagonist |
| Mixed anemia (AI/IDA) | Normal | Low TSAT, low to normal ferritin | Intravenous† | Antagonist |
| Chronic kidney disease | High | Variable | Intravenous‡ | Antagonist |
| Resistance to ESA therapy (functional iron deficiency) | High | Low TSAT, variable ferritin | Intravenous | Antagonist |
| Iron-refractory iron deficiency anemia (IRIDA) | High | Low TSAT and ferritin | Intravenous only | Antagonist |
| Iron-loading anemias (eg, ineffective erythropoiesis) | Low | High TSAT and ferritin | Iron-chelation therapy | Agonist |
| Iron-loading anemias treated with transfusion | Normal to high | High TSAT and ferritin | Iron-chelation therapy | Agonist |