Long Anaemia of Long Covid

Elevated levels of the peptide hormone hepcidin seems to be central to the low iron pattern with long covid.

This pattern is likely to affect women more significantly than men.

Ganz, Tomas. “Hepcidin and iron regulation, 10 years later.” Blood 117 17 (2011): 4425-33 .

Transcript

Hi, I'm Dr Philip McMillan and I just wanted to share some thoughts about a recently published paper on the 1st of March 2024 looking at an dysregulation, an inflammatory stress erythropoiesis associated with long-term outcome of Covid-19, technically Long Covid, and it's just to let you understand the mechanism that is likely to be occurring and truthfully why it could be complicated to be managed from a clinical point of view.

So the basis of the low iron because the study which was as I said done in March published in March 2024 has generally identified that there is a problem with iron regulation in the patients with Long Covid

So even though they may have normal levels of iron in their body there's a defect or a dysregulation in the homeostasis which then impacts on the ability of the body to make red blood cells.

What has happened is that it's just part of a standard inflammatory process so the body does a number of things when there is inflammation and it could be inflammation from infection or inflammation from say immunity autoimmune diseases

What happens is that a specific cytokine, interleukin 6 (IL-6), will stimulate the liver to produce a peptide hormone called hepcidin.

And the purpose of that is to reduce the accessibility of iron in the bloodstream.

and that's because some bacteria can use iron and therefore the body is restricting its access to it as part of a compensatory mechanism so it does this by blocking a transporter inside cells that tend to have higher levels of iron and so therefore the iron gets trapped in these cells so it can't get out

What's interesting is that even though there is a trapping of iron in the cells, at the same time there is a higher level of the inflammatory storage form of iron called ferritin.

So what you have is a higher level of hepcidin, a higher level of ferritin and so the body is unable to use that iron to be able to make red blood cells so it seems that the longer term issue is that we see these conditions we call inflammatory anemias where people who have chronic inflammation. They end up with an anemia over a long period of time just because the body cannot utilize and in an efficient and effective way and that seems to be one of the issues that we're going to see going forward with Long Covid it takes some time for it to occur but based on the fact that women lose blood each month

There is a strong possibility that this anaemia is likely to be worse in women than it is in men.

And in a situation where you have people who are already fatigued because of the inflammatory process around Long Covid, they have post-exertional malaise, this is likely to be exacerbated.

And it may be one of the reasons why we see from a research point of view that women are more affected than men.

What can we do about it?

It may seem logical to be able to take iron supplements. The problem is, is that hepcidin also blocks the uptake of iron from the intestine. So it's unlikely that the body is going to absorb it. So the only way out seems to be to suppress the inflammatory response.

This is why I said going back to understanding where exactly the inflammation was located prior to the onset of Covid?

That is where the long-term answer to managing the disease is.

Where was that inflammatory process?

How can it be managed and what can be done to set that inflammatory process back in a normal line?

That's the challenge that we'll have to face over the longer term but it does mean that treating Long Covid is going to be tough.

Thank you.