Potential role of hepcidin in the diagnosis and management of anemia
| Condition . | Expected hepcidin levels . | Iron variables . | Iron therapy strategies . | Potential hepcidin therapy . |
|---|---|---|---|---|
| Absolute IDA | Low | Low Tsat and ferritin | PO (or IV if PO poorly tolerated or malabsorbed) | No |
| Functional iron deficiency (ESA therapy, CKD) | Variable, depending on the severity and etiology of CKD | Low Tsat, variable ferritin | IV or oral if low disease activity | Antagonist (if hepcidin levels not low) |
| Iron sequestration (AI) | High | Low Tsat, normal to elevated ferritin | IV | Antagonist |
| Mixed anemia (AI/IDA or AI/functional iron deficiency) | Variable | Low Tsat, low to normal ferritin | IV or oral if low disease activity | Antagonist (if hepcidin levels not low) |
| 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 variables . | Iron therapy strategies . | Potential hepcidin therapy . |
|---|---|---|---|---|
| Absolute IDA | Low | Low Tsat and ferritin | PO (or IV if PO poorly tolerated or malabsorbed) | No |
| Functional iron deficiency (ESA therapy, CKD) | Variable, depending on the severity and etiology of CKD | Low Tsat, variable ferritin | IV or oral if low disease activity | Antagonist (if hepcidin levels not low) |
| Iron sequestration (AI) | High | Low Tsat, normal to elevated ferritin | IV | Antagonist |
| Mixed anemia (AI/IDA or AI/functional iron deficiency) | Variable | Low Tsat, low to normal ferritin | IV or oral if low disease activity | Antagonist (if hepcidin levels not low) |
| 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 |
CKD, chronic kidney disease; PO, by mouth; Tsat, transferrin saturation.