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Tareq Abadl: Anemia of Inflammation – Hepcidin Regulation of Iron
Tareq Abadl/LinkedIn
Mar 13, 2026, 16:18

Tareq Abadl: Anemia of Inflammation – Hepcidin Regulation of Iron

Tareq Abadl, Medical Laboratory Specialist and Director of the Blood Bank at Dr. Abdelkader Al-Mutawakkil Hospital, shared a post on LinkedIn:

“Hepcidin – the iron gatekeeper

When hepcidin is high – serum iron and transferrin saturation (TSAT) are decreased — even if total body iron stores are normal.

This is the central mechanism behind anemia of inflammation (functional iron deficiency).

Why laboratories should care

1. Diagnostic power

Hepcidin measurement strengthens the differential diagnosis of anemia:

  • Low hepcidin – true iron-deficiency anemia (IDA)
  • High or normal hepcidin – anemia of chronic disease (ACD)/functional iron deficiency

This distinction directly determines whether oral iron therapy will succeed or fail.

Recent reviews and cohort studies consistently support hepcidin as a valuable adjunct marker in complex anemia workups.

2.Therapeutic prediction

Elevated hepcidin predicts poor response to oral iron.

It may guide clinicians toward:

  • IV iron therapy
  • Anti-inflammatory strategies
  • CKD-specific management pathways

Assays — What Labs Must Know Before Implementation

Two main methodologies:

1. LC-MS/MS (Mass Spectrometry)

  • High specificity
  • Better harmonization potential
  • Considered reference-grade

2. Immunoassays

  • Convenient and commercially available
  • Tend to read higher than MS methods
  • Greater inter-platform variability, especially in inflammatory states

Do not mix values from different platforms. Know exactly which method your lab is using.

Standardization status

Harmonization is improving – but not perfect.

Proficiency testing shows inter – method variability.

Before offering clinical reporting:

  • Perform method comparison with a reference lab
  • Participate in external quality assessment (EQA) programs
  • Establish internal QC material

Pre-analytical and reporting essentials

Proper pre-analytics are critical for reliable results:

  • Use validated specimen type (EDTA plasma vs serum – assay dependent)
  • Control time – to – centrifugation
  • Avoid hemolysis
  • Aliquot promptly
  • Store at −80 degrees Celsius  for batch analysis

Every report must include:

  • Specimen type
  • Analytical method
  • Reference interval

Clinical interpretation without these details is risky.

Clinical interpretation framework

  • Low hepcidin plus low ferritin plus low TSAT
    True iron deficiency
    Oral iron usually appropriate
  • High/normal hepcidin plus low TSAT plus normal/high ferritin
    Functional iron sequestration (inflammation, CKD)
    Consider IV iron or treat underlying inflammation
    Oral iron likely ineffective
  • Borderline cases

Interpret alongside:

  • Ferritin
  • CRP
  • TSAT

Clinical context (infection, CKD, pregnancy, recent transfusion)

Practical rollout checklist for laboratories

  • Define the clinical use case (diagnostic reflex? research? clinician-requested test?)
  • Select assay method
  • Perform method comparison vs reference lab
  • Finalize pre-analytical SOPs
  • Train phlebotomy and processing staff
  • Implement internal QC plus enroll in proficiency testing
  • Add LIS interpretative comments to guide clinicians.”

Tareq Abadl

Other posts featuring Tareq Abadl on Hemostasis Today.

anemia Anti-inflammatory strategies CKD-specific management pathways Dr. Abdelkader Al-Mutawakkil Hospital Health Hematology Hemostasis Hemostasis News Hemostasis Today hepcidin Iron-Deficiency IV iron therapy Medicine Tareq Abadl Transferrin Saturation
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