Abstract
To explore the metabolic levels of ERFE (Erythroferrone) and Hepcidin in pregnant women with thalassemia combined with iron deficiency anemia (IDA), and to analyze the differences in serum ERFE, Hepcidin levels and iron-related indicators before and after iron supplementation in these pregnant women, providing a theoretical basis and effective monitoring indicators for the clinical iron supplementation treatment of pregnant women with thalassemia combined with IDA. The experimental groups comprised:50 thalassemia-monotherapy cases (THAL group), 54 thalassemia with iron-deficiency anemia cases (THAL-IDA group),50 iron-deficiency anemia cases (IDA group).All cases were diagnosed between April 2023 and September 2024, with 50 healthy pregnant women from the same period serving as controls (NC group).All pregnant women had serum and plasma samples collected to measure indicators such as Erythroferrone (ERFE), Hepcidin, complete blood count, and ferritin. The differences in these indicators among the groups were analyzed.For patients in the IDA Group and the THAL-IDA Group, after 4 weeks of iron supplementation using a standardized protocol, blood samples were re-collected to measure the aforementioned indicators and compare the changes before and after iron therapy. (1) General Characteristics, Erythrocyte Parameters, and SF Analysis Across Experimental and Control Groups. Hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) in all experimental groups were significantly lower than those in the NC group, while ERFE levels were significantly higher (P < 0.05). Serum ferritin (SF) and Hepcidin levels were significantly elevated in the NC and THAL groups compared to other groups (P < 0.05), though no significant difference existed between the NC and THAL groups (P > 0.05). Within experimental groups, the THAL group exhibited the highest Hepcidin and SF levels, while the IDA group showed the lowest (P < 0.05). ERFE levels in thalassemia groups (THAL and THAL-IDA) were significantly higher than in non-thalassemia groups (NC and IDA) (P < 0.05). The --(SEA)/αα genotype predominated in both thalassemia groups (34% in THAL and 42.6% in THAL-IDA). (2) Changes in Erythrocyte Parameters, SF, ERFE, and Hepcidin Levels Pre- and Post-Iron Supplementation in IDA and THAL-IDA Groups. In the IDA group, Hb, MCV, MCH, MCHC, SF, and Hepcidin levels significantly increased post-supplementation (P < 0.05), while ERFE remained unchanged. In the THAL-IDA group, MCV, MCH, MCHC, and SF levels significantly improved post-supplementation (P < 0.05), with no significant changes in Hb, ERFE, or Hepcidin. (3) Correlation analysis of ERFE, Hepcidin, SF, and Erythrocyte Parameters Across Groups. In the THAL-IDA group, ERFE and Hepcidin levels showed strong positive correlations both pre- and post-supplementation (pre: r = 0.68, P < 0.05; post: r = 0.67, P < 0.05). In the IDA group, Hepcidin and SF were positively correlated pre-supplementation (r = 0.92, P < 0.05) but negatively correlated post-supplementation (r = -0.87, P < 0.05). There are differences in iron metabolism between isolated IDA and THAL-IDA pregnant women. Iron supplementation effectively improves anemia and increases Hepcidin levels in isolated IDA patients. However, in THAL-IDA patients, iron therapy alleviates iron deficiency but has limited effects on Hb and Hepcidin levels. Dynamic monitoring of Hepcidin can help assess the safety of iron supplementation in such patients.