Albertine Donker

General Introduction 37 1 PART II: DIAGNOSTIC STUDIES: FOCUSON IRONREFRACTORY IRONDEFICIENCY ANEMIA Measurement of serum hepcidin plays an important role in the diagnosis of iron related disorders, especially of IRIDA. In children, diagnosing IRIDA is hampered by the lack of pediatric studies defining reference values of serum hepcidin in healthy children of different age groups, relative to iron status. Therefore, we assessed serum hepcidin levels in healthy children from different age groups, relative to body iron indicators. The results are presented in Chapter 7. 146 Since the cardinal feature of IRIDA is a discrepantly high serum hepcidin in relation to the low circulating iron levels, we hypothesize that the TSAT/hepcidin ratio could be a useful diagnostic tool in order to discriminate between IRIDA and patients presenting with an iron deficient microcytic anemia because of other reasons, e.g., inadequate intake, blood loss or other forms of refractory IDA, such as celiac disease, autoimmune gastritis, and Helicobacter pylori. 102,147,148 However, before its introduction as a diagnostic test in the work up of iron deficient microcytic anemic in patients suspected for the presence of IRIDA, the ratio needs confirmation. In Chapter 8 we assessed the TSAT/hepcidin ratio in adult non-IRIDA IDA patients. PART III: DISCUSSION, SUMMARY AND ADDENDA In Chapter 9 we discuss the results of our studies and the still unsolved issues, after which we suggest future perspectives and a research agenda. In Chapter 10 we summarize our work. Chapter 11 contains the addenda of this thesis.