Serum Hepcidin Levels as Predictors of Transfusion Requirement in β-Thalassemia Major: Cross-sectional Correlation with Ferritin and Erythropoietic Markers
21Division of Hematopathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
2Department of Medicine, University of KwaZulu-Natal, Durban, South Africa
DOI: 10.18081/ajbm.2025.4.352
ABSTRACT
Background
β-Thalassemia major is characterised by ineffective erythropoiesis and lifelong transfusion dependence, leading to progressive iron overload. Although serum ferritin is widely used to assess iron burden, it does not reliably reflect erythropoietic activity or transfusion requirement. Hepcidin, a key regulator of iron homeostasis, is known to be dysregulated in thalassemia; however, its relationship with transfusion burden remains incompletely defined, particularly in African populations.
Objective
To evaluate serum hepcidin levels in patients with β-thalassemia major and to examine their association with transfusion requirement, serum ferritin, and selected erythropoietic markers.
Methods
This cross-sectional study was conducted at tertiary hematology centres in South Africa between January 2023 and December 2024. Patients with confirmed β-thalassemia major receiving regular transfusion therapy were enrolled. Clinical data, transfusion history over the preceding 12 months, and laboratory parameters were collected. Serum hepcidin was measured using enzyme-linked immunosorbent assay, while ferritin and hematologic indices were assessed using standard laboratory methods. Correlation analyses and multivariable regression were performed to identify predictors of transfusion requirement.
Results
Seventy-two patients were included in the analysis. Median serum hepcidin levels were low relative to iron burden, while serum ferritin levels were markedly elevated across the cohort. Serum hepcidin demonstrated a significant inverse correlation with annual transfusion volume and transfusion frequency. In contrast, no consistent correlation was observed between serum hepcidin and ferritin levels. Hepcidin also showed a strong inverse association with reticulocyte count and a positive association with pre-transfusion haemoglobin. In multivariable analysis, serum hepcidin remained an independent predictor of transfusion requirement, whereas ferritin did not.
Conclusion
In UK real-world practice, first-line amivantamab-based therapy demonstrated a clinically meaningful PFS advantage over osimertinib, particularly among patients with MET-associated biology, though OS differences were not yet evident. These findings support the emerging role of early dual EGFR/MET inhibition and highlight the importance of comprehensive molecular profiling to optimise first-line treatment selection. Longer follow-up and prospective studies are warranted to refine sequencing strategies and confirm survival impact.
Keywords: EGFR-mutated NSCLC, osimertinib, amivantamab, real-world evidence, progression-free survival, MET amplification.
Recommended Citation
Thompson E, Carter D, Rahman A. Serum Hepcidin Levels as Predictors of Transfusion Requirement in β-Thalassemia Major:
Cross-sectional Correlation with Ferritin and Erythropoietic Markers. Advanced Journal of Biomedicine & Medicine. 2025;13(4):352-365. doi:10.18081/ajbm.2025.4.352
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2025 Vol 13, Issue 4 Pages 352-365