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Prepublished online as a Blood First Edition Paper on June 28, 2002; DOI 10.1182/blood-2002-04-1260.
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Blood, 15 November 2002, Vol. 100, No. 10, pp. 3776-3781
RED CELLS
Inappropriate expression of hepcidin is associated with iron
refractory anemia: implications for the anemia of chronic
disease
David A. Weinstein,
Cindy
N. Roy,
Mark D. Fleming,
Massimo F. Loda,
Joseph I. Wolfsdorf, and
Nancy C. Andrews
From Children's Hospital, Harvard Medical School;
Brigham and Women's Hospital and Harvard Medical School; Dana-Farber
Cancer Institute; and Howard Hughes Medical Institute, Children's
Hospital, Harvard Medical School; all of Boston, MA.
The anemia of chronic disease is a prevalent, poorly understood
condition that afflicts patients with a wide variety of diseases, including infections, malignancies, and rheumatologic disorders. It is
characterized by a blunted erythropoietin response by erythroid precursors, decreased red blood cell survival, and a defect in iron
absorption and macrophage iron retention, which interrupts iron
delivery to erythroid precursor cells. We noted that patients with
large hepatic adenomas had severe iron refractory anemia similar to
that observed in anemia of chronic disease. This anemia resolved
spontaneously after adenoma resection or liver transplantation. We
investigated the role of the adenomas in the pathogenesis of the anemia
and found that they produce inappropriately high levels of hepcidin
mRNA. Hepcidin is a peptide hormone that has been implicated in
controlling the release of iron from cells. We conclude that hepcidin
plays a major, causative role in the anemia observed in our subgroup of
patients with hepatic adenomas, and we speculate that it is important
in the pathogenesis of the anemia of chronic disease in general.

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