Hepcidin is a peptide hormone made by the liver. It is considered the master regulator of iron metabolism in the body and determines how much iron passes from the gut and stores into the blood.
Understanding hepcidin explains why, with inflammation and chronic disease, iron gets 'stuck' in the tissues, and iron deficiency in the blood develops even with full stores.
How hepcidin works
The only protein that moves iron out of cells into the blood is ferroportin. Hepcidin binds to it and makes it break down. When there is a lot of hepcidin, ferroportin 'closes': iron does not leave the gut cells (iron absorption drops) and is locked away in macrophages — the blood iron level falls. When there is little hepcidin, iron flows freely into the bloodstream.
Hepcidin and anemia of chronic disease
Hepcidin production is raised by inflammation (via interleukin-6) and by overfilled iron stores, and lowered by iron deficiency, active blood cell production and hypoxia. In chronic inflammation, infections, cancer and kidney disease, hepcidin stays persistently high: anemia of chronic disease develops — there is enough iron in the body, but it is unavailable for blood cell production (functional deficiency).
Practical significance
It is precisely because of hepcidin that ferritin rises with inflammation and can mask a true iron deficiency. The same explains why, during active inflammation, iron tablets are poorly absorbed and intravenous administration is sometimes preferable. Hepcidin itself is so far used mainly in research, not as a routine test.
Calculate using this marker
Calculators where Hepcidin is used directly:
Frequently asked questions
Why is ferritin high but blood iron low during inflammation?
Hepcidin is to blame: inflammation raises it, ferroportin is blocked, and iron is locked inside cells. Ferritin meanwhile rises as an acute-phase protein, but the iron is unavailable for blood cell production.
Is hepcidin measured as a test?
In routine practice — rarely: there is no standardized mass test yet. Iron metabolism is assessed by ferritin, transferrin saturation and inflammation markers, while hepcidin is more often used in research.