Association between serum levels of hepcidin and ferritin in patients with thalassemia major and intermedia, the role of iron chelator

Patients with beta-thalassemia suffer from iron overload, and hepcidin, as the main regulator of iron hemostasis, can indicate iron overload better than serum ferritin, but changes in serum hepcidin levels are affected by the type of thalassemia (major or intermediate) and by type of treatments. The present study aimed to determine the correlation between serum levels of hepcidin and ferritin in patients with thalassemia major and intermedia under chelation therapy. This cohort study investigated 143 patients with thalassemia (122 patients with thalassemia major and 21 patients with and thalassemia intermedia) who referred to Thalassemia Center of Qom University of Medical Sciences, Qom, Iran. The serum level of ferritin was measured twice in all patients: in the beginning and after taking iron chelator by ECL method. Hepcidin was assayed at the end of the study by ELISA methods. Demographic data and clinical history of the patients (type of disease, type of drugs used, and blood transfusion history) were completely recorded. The mean serum level of hepcidin in the TM group (2249.62 ± 1547.37 ng/ml) was greater than the TI group (1482.43 ± 1314.26 ng/ml) (p = 0.007). However, there was no meaningful difference in serum ferritin level between the two groups (2997.74 ± 2545.66 vs. 2670.62 ± 2670.04 ng/ml, p > 0.05). Serum ferritin and hepcidin levels were not correlated both in TM or TI patients (p > 0.05). However, evaluating the trend of changes in serum levels of ferritin with hepcidin showed a significant association. High serum levels of ferritin indicated high iron overload in both groups, TM and TI, which decreased after treatment with chelators. The higher hepcidin levels in TM patients in comparison to TI patients could reflect the higher iron overload in these patients. However, further cellular studies are needed to evaluate the accuracy of these tests in the assessment of iron overload.