Growth differentiation factor 15 expression in anemia of chronic disease and iron deficiency anemia

Background: Growth differentiation factor 15 (GDF15) expression, at the high levels achieved in the setting of ineffective erythropoiesis, contributes toward pathological iron overloading through a mechanism of incomplete hepcidin suppression. In addition to the regulation of hepcidin, iron depletion or chelation in the host may regulate GDF15 expression.Objectives: This study aimed to detect GDF15 expression in Egyptian patients with iron deficiency anemia (IDA) and anemia of chronic disease (ACD) to examine its possible role in their differentiation.Patients and methods: GDF15 was detected using an enzyme-linked immunosorbent assay in 40 patients (20 with IDA and 20 with ACD) and 10 age-matched and sex-matched healthy controls.Results: The IDA group showed a decrease in the mean values of hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), serum iron and ferritin, and higher total iron-binding capacity (TIBC) compared with the controls (P⩽0.001). The ACD group had a statistically significantly higher mean value of GDF15 than the control and IDA groups (P⩽0.001). The mean values of Hb, MCV, serum iron, and TIBC were statistically significantly lower, with higher serum ferritin in the ACD group compared with the controls (P⩽0.001, P=0.01, P⩽0.001, P⩽0.001, and P=0.004, respectively). Higher mean values of MCV, MCH, and ferritin were found in the ACD compared with the IDA groups (P⩽0.001), whereas TIBC was higher in the IDA group compared with the ACD groups (P⩽0.001). No statistically significant correlation was found between the serum GDF15 level and the laboratory data studied among the ACD and IDA groups (P 0.05). No difference was found between serum C-reactive protein-positive and serum C-reactive protein-negative ACD groups in the laboratory parameters studied (P 0.05).Conclusion: GDF15 plays an important role in the pathogenesis of ACD and IDA, and it can be used as a potential marker in their differentiation. Although GDF15 is linked to iron homeostasis in IDA, its increased concentrations in ACD are mostly because of inflammation.