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A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi

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Huibers, Minke HW, Calis, Job C, Allain, Theresa, Coupland, Sarah E, Phiri, Chimota, Phiri, Kamija S, Swinkels, Dorine W, Boele van Hensbroek, Michael and Bates, Imelda ORCID: https://orcid.org/0000-0002-0862-8199 (2020) 'A possible role for hepcidin in the detection of iron deficiency in severely anaemic HIV-infected patients in Malawi'. PLoS ONE, Vol 15, Issue 2, e0218694.

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Abstract

Introduction: Iron deficiency is a treatable cause of severe anaemia in low-and-middle-income-countries (LMIC). Diagnosing it remains challenging as peripheral blood markers poorly reflect bone-marrow iron deficiency (BM-ID), especially in the context of HIV-infection.
Methods: Severely anaemic (haemoglobin ≤70g/l) HIV-infected adults were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. BM-ID was evaluated. Accuracy of blood markers (including hepcidin, mean corpuscular volume, mean cellular haemoglobin concentration, serum iron, serum ferritin, soluble transferrin receptor (sTfR), sTfR -index, sTfR –ratio) to detect BM-ID was evaluated by ROC area under the curve (AUCROC ).
Results: Seventy-three patients were enrolled and 35 (48.0%) had BM-ID. Although hepcidin and MCV performed best ( AUCROC of 0.593 and 0.545 respectively), all markers performed poorly in identifying BM-ID (ROC<0.6). The AUCROC of hepcidin in males was 0.767 (sensitivity 80%, specificity 78%) and in women 0.490 (sensitivity 60%, specificity 61%).
Conclusion: BM-ID deficiency was common in severely anaemic HIV-infected patients. It is an important and potential treatable contributor to severe anaemia but lack of definitive biomarkers makes it difficult to accurately assess iron status in these patients. Further investigation of the potential of hepcidin is needed, including exploration of the differences in hepcidin results between males and females.

Item Type: Article
Subjects: QS Anatomy > QS 4 General works. Classify here works on regional anatomy
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 155 Anemia
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 312 Hemorrhagic disorders (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0218694
Depositing User: Rachel Dominguez
Date Deposited: 28 Feb 2020 12:33
Last Modified: 28 Feb 2020 16:25
URI: https://archive.lstmed.ac.uk/id/eprint/13855

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