Inflammation Driven Dysregulation of Iron Homeostasis in COVID 19 Patients: An Insight into Anemia

Abstract

Introduction: COVID virus predominantly affects the respiratory system and can also affect other systems due to hematological pathologies .The cytokine surge in COVID19 inhibits erythropoietin leading to hematological pathologies like anemia.

Objectives: This study explores the effect of inflammatory markers on iron dysregulation in COVID patients with and without anemia.                    .

Methods: 100 COVID patients confirmed by RT- PCR were divided into anemic and nonanemic groups comprising 50 patients each. Patients with Hb ≤ 12g/dl were included in anemic group. Plasma iron regulatory proteins and inflammatory markers were estimated by spectrophotometric methods using Roche Cobas Pro autoanalyser.

Results: Hepcidin and erythropoietin were prominently higher in anemic patients compared to nonanemic patients (p=0.000).Compared to nonanemic patients markers of coagulation and hemolysis which included D Dimer and LDH showed a marked increase in the anemic group. Further indices of inflammation like CRP, IL6 and procalcitonin also increased significantly in anemic group (p= 0.027, p= 0.018) respectively. Significantly high plasma transaminases and creatinine in the anemic group point to the early onset of hepatic and renal dysfunction due to anemia. Low hemoglobin would have induced thrombotic changes that culminated in the elevation of D Dimer. IL6 released by the virus induces hepcidin synthesis resulting in hyperferritinemia and decreased erythropoiesis due to restricted availability of iron.

Conclusions: Dysregulation of iron homeostasis observed in COVID 19 patients with anemia is inflammation driven, emphasizing the important crosstalk between inflammatory molecules and iron regulatory proteins. Further, anemia along with coagulopathy may aggravate the organ dysfunction in these patients.