Hepcidin is a protein produced by the liver which may explain many of the features of anemia of chronic disease. It plays a key role in iron absorption and mobilization.


Structure: 25 amino acids, rich in disulfides


Production of hepcidin is increased in systemic inflammatory reactions due to the effects of cytokines, especially IL-6.


Hepcidin binds to ferroportin-1, resulting in its degradation. This results in:

(1) decreased absorption of iron from the gastrointestinal tract into plasma

(2) decreased release of iron from iron stores into plasma


Features of anemia of chronic disease:

(1) anemia with low serum iron and high ferritin

(2) elevated plasma hepcidin levels

(3) systemic disorder with release of cytokines

(4) poor response to erythropoietin (partially because of cytokines and partially because of the functional iron deficiency)


Perhaps this explains the efficacy of parenteral iron administration.


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