Increased hepcidin production impairs iron metabolism after pancreatoduodenectomy

The duodenum is a central organ for iron absorption. This study was performed to evaluate changes in body iron concentration and other iron-related molecules sequentially, in patients undergoing pancreatoduodenectomy (PD).

Twenty-one patients who had undergone PD at our department were enrolled in the study. Measurements of serum iron (sFe), total iron-binding capacity (TIBC), serum ferritin (sFer), C-reactive protein (CRP), interleukin-6 (IL-6), hemoglobin (Hb), hematocrit (Ht), and serum hepcidin (sHep) were performed before surgery (Pre), and on postoperative days 3 (D3), 7 (D7), and 14 (D14).

The median values of sFe on Pre, D3, D7, and D14 were 73.0, 30.0, 33.0, and 41.0 microg/ dL, respectively (P < 0.05), and those of TIBC were 276.0, 160.0, 176.0, and 165.0 microg/ dL, respectively (P < 0.05). CRP and IL-6 became maximal on D3. The median values of sHep on Pre, D3, D7, and D14 were 18.9, 42.9, 25.7, and 21.2 mg/dL, respectively (P < 0.05). Hb and Ht reached minimum values on D3 and remained low until D14. The median values of sFer on Pre, D3, D7, and D14 were 135, 301, 267, and 233 ng/ dL, respectively.

Hepcidin production is increased after pancreatoduodenectomy. Because hepcidin is known to divert iron to storage-type ferritin rather than to erythropoiesis, iron administration intended for erythropoiesis during this period may be ineffective.