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Clinical significance of serum IL-6, TNF-&alph;, Hepcidin, and EPO levels in anaemia of chronic disease and iron deficiency anaemia: The laboratory indicators for anaemia

Hava Uskudar Teke, Dondu Uskudar Cansu, Pinar Yildiz, Gokhan Temiz, Cengiz Bal

Background: Pathogenesis of anaemia of chronic disease is multifactorial. It is related with corrupted erythropoietin-dependent erythropoiesis due to C-reactive protein, and pro-inflammatory cytokines, such as interleukin-6 and tumor necrosis factor-alpha. It is also related with decreased red cell survival and impaired iron mobilization. Hepcidin level in iron deficiency anaemia is low than controls but it is high in patients with chronic renal failure. Pro-inflammatory cytokines are associated with the pathogenesis of rheumatoid arthritis and development of anaemia in rheumatoid arthritis.

Methods: In this study we aimed to evaluate the relationship between serum hepcidin, interleukin-6, tumor necrosis factor-alpha, erythropoietin levels and whole blood count parameters and clinical properties of patients with iron deficiency anaemia, chronic renal failure and rheumatoid arthritis which were compared with control group, in addition we also aimed to evaluate the differences between patients and controls. Serum interleukin-6, tumor necrosis factor-alpha, hepcidin and erythropoietin levels of 31 patients with iron deficiency anaemia, 15 patients with rheumatoid arthritis, 18 patients with chronic renal failure and 31 healthy controls were measured from peripheral blood samples.

Results: We found no differences between groups according to hepcidin and tumor necrosis factor-alpha levels but we found higher interleukin-6 levels and lower erythropoietin levels in patients with anaemia of chronic disease.

Conclusion: Ferritin is the most valuable parameter for making the differential diagnose of anemia of chronic disease and iron deficiency anemia, in anemic patients but in some situations that ferritin cannot help for making the differential diagnose, interleukin-6 and erythropoietin may be useful for making the differential diagnose of iron deficiency anemia, and anemia of chronic disease.