Iron metabolism and hepcidin
Where the body's 3 to 4 g of iron sits, how the duodenum absorbs it and macrophages recycle it, how hepcidin and ferroportin set plasma iron, the cellular IRP/IRE switch, and how these explain anaemia of inflammation, haemochromatosis, iron overload in thalassaemia, alternate-day oral iron and the new hepcidin mimetic rusfertide.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- An adult has 3 to 4 g of iron: about two-thirds in haemoglobin, up to 1 g in stores (ferritin, haemosiderin) in men and less in premenopausal women, and only about 3 mg on transferrin at any moment.
- The body absorbs 1 to 2 mg a day and has no regulated way to excrete iron. Control happens at absorption and release.
- The liver hormone hepcidin shuts ferroportin, the only cellular iron exporter. High hepcidin means low plasma iron; low hepcidin means iron floods in.
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Sources
- Hoffbrand's Essential Haematology (8th ed.)Wiley-Blackwell (Hoffbrand and Steensma, 2019), 2019
- Patient Blood Management GuidelinesAU/NZNational Blood Authority (modules 1 to 6, 2011 to 2016)
- Systemic iron homeostasisPhysiological Reviews (Ganz, 2013;93:1721-1741), 2013
- Identification of erythroferrone as an erythroid regulator of iron metabolismNature Genetics (Kautz et al., 2014;46:678-684), 2014
- Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trialsLancet Haematology (Stoffel et al., 2017;4:e524-e533), 2017
- Rusfertide, a hepcidin mimetic, for control of erythrocytosis in polycythemia vera (REVIVE, phase 2)New England Journal of Medicine (Kremyanskaya et al., 2024;390:723-735), 2024
- VERIFY: a phase III trial of rusfertide versus placebo in phlebotomy-dependent patients with polycythemia vera receiving standard-of-care therapyJournal of Clinical Oncology (Kuykendall et al., 2026, published online October 2026), 2026
- FDA approves rusfertide for erythrocytosis in adults with polycythemia veraThe ASCO Post, 2026
- Effects of iron isomaltoside vs ferric carboxymaltose on hypophosphatemia in iron-deficiency anemia: two randomized clinical trialsJAMA (Wolf et al., 2020;323:432-443), 2020
- Last updated
- 14 November 2026
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