CLINICAL RESEARCH: HEART FAILURE
Etiology of Anemia in Patients With Advanced Heart Failure
John N. Nanas, MD, PhD, FESC*,*,
Charis Matsouka, MD ,
Drosos Karageorgopoulos, MD*,
Anastasia Leonti, MD ,
Elias Tsolakis, MD*,
Stavros G. Drakos, MD*,
Eleftheria P. Tsagalou, MD*,
George D. Maroulidis, MD*,
George P. Alexopoulos, MD*,
John E. Kanakakis, MD* and
Maria I. Anastasiou-Nana, MD, FESC*
* Department of Clinical Therapeutics, University of Athens School of Medicine
Hematology
Nuclear Cardiology, "Alexandra" Hospital, Athens, Greece
Manuscript received February 21, 2006;
revised manuscript received August 1, 2006,
accepted August 7, 2006.
* Reprint requests and correspondence: Dr. John N. Nanas, 24 Makedonias, 10433 Athens, Greece (Email: jnanas{at}ath.forthnet.gr).
OBJECTIVES: We prospectively investigated the causes of anemia in patients with advanced congestive heart failure (CHF).
BACKGROUND: Anemia is common in patients with advanced CHF, and its etiology is generally considered to be multifactorial. However, despite its importance, precise information is lacking regarding the prevalence of putative etiologic factors.
METHODS: Patients who were hospitalized for decompensated advanced CHF and who were stabilized after their initial treatment underwent evaluation of "clinically significant" anemia, defined as a hemoglobin content <12 g/dl for men and <11.5 g/dl for women. Patients with a serum creatinine concentration >3 mg/dl or patients with concurrent diseases that are known to cause anemia were not included. The initial evaluation included measurements of vitamin B12, folic acid, thyroid-stimulating hormone, erythropoietin, lactate dehydrogenase, Coombs test, multiple fecal occult tests, and bone marrow aspiration. Patients without diagnosis by these methods underwent red cell mass measurement with 51Cr assay.
RESULTS: The mean age of the 37 patients was 57.9 ± 10.9 years and mean left ventricular ejection fraction 22.5 ± 5.9%. Iron deficiency anemia was confirmed by bone marrow aspiration in 27 patients (73%), 2 patients (5.4%) had dilutional anemia, and 1 patient (2.7%) had drug-induced anemia. No specific cause was identified in 7 patients (18.9%) who were considered to have "anemia of chronic disease." Serum ferritin for the iron-deficient patients was not a reliable marker of iron deficiency in this population.
CONCLUSIONS: In this group of patients, iron deficiency was the most common cause of anemia. The iron status of patients with end-stage chronic CHF should be thoroughly evaluated and corrected before considering other therapeutic interventions.
|
Abbreviations and Acronyms
| | CHF = congestive heart failure | | NYHA = New York Heart Association |
|
Related Article
-
Anemia in Heart Failure: Time to Rethink Its Etiology and Treatment?
- G. William Dec
J. Am. Coll. Cardiol. 2006 48: 2490-2492.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
D. O. Okonko, A. K. J. Mandal, C. G. Missouris, and P. A. Poole-Wilson
Disordered Iron Homeostasis in Chronic Heart Failure: Prevalence, Predictors, and Relation to Anemia, Exercise Capacity, and Survival
J. Am. Coll. Cardiol.,
September 13, 2011;
58(12):
1241 - 1251.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. X. O'Brien
Iron Metabolism, Anemia, and Heart Failure
J. Am. Coll. Cardiol.,
September 13, 2011;
58(12):
1252 - 1253.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. T. Maeder, O. Khammy, C. dos Remedios, and D. M. Kaye
Myocardial and Systemic Iron Depletion in Heart Failure: Implications for Anemia Accompanying Heart Failure
J. Am. Coll. Cardiol.,
July 26, 2011;
58(5):
474 - 480.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. McMurray and P. Ponikowski
Heart Failure: Not Enough Pump Iron?
J. Am. Coll. Cardiol.,
July 26, 2011;
58(5):
481 - 482.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Ruiter, S. Lankhorst, A. Boonstra, P. E. Postmus, S. Zweegman, N. Westerhof, W. J. van der Laarse, and A. Vonk-Noordegraaf
Iron deficiency is common in idiopathic pulmonary arterial hypertension
Eur. Respir. J.,
June 1, 2011;
37(6):
1386 - 1391.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Silverberg, A. Iaina, D. Wexler, and D. Schwartz
Iron Repletion in Heart Failure Patients
Hypertension,
March 1, 2011;
57(3):
381 - 382.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Gonzalez-Costello and J. Comin-Colet
Iron deficiency and anaemia in heart failure: understanding the FAIR-HF trial
Eur J Heart Fail,
November 1, 2010;
12(11):
1159 - 1162.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. A. Jankowska, P. Rozentryt, A. Witkowska, J. Nowak, O. Hartmann, B. Ponikowska, L. Borodulin-Nadzieja, W. Banasiak, L. Polonski, G. Filippatos, et al.
Iron deficiency: an ominous sign in patients with systolic chronic heart failure
Eur. Heart J.,
August 1, 2010;
31(15):
1872 - 1880.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Sasu, K. S. Cooke, T. L. Arvedson, C. Plewa, A. R. Ellison, J. Sheng, A. Winters, T. Juan, H. Li, C. G. Begley, et al.
Antihepcidin antibody treatment modulates iron metabolism and is effective in a mouse model of inflammation-induced anemia
Blood,
April 29, 2010;
115(17):
3616 - 3624.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Lipsic and P. van der Meer
Erythropoietin, iron, or both in heart failure: FAIR-HF in perspective
Eur J Heart Fail,
February 1, 2010;
12(2):
104 - 105.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. M. Felker
Too Much, Too Little, or Just Right?: Untangling Endogenous Erythropoietin in Heart Failure
Circulation,
January 19, 2010;
121(2):
191 - 193.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. D. Anker, J. C. Colet, G. Filippatos, R. Willenheimer, K. Dickstein, H. Drexler, T. F. Luscher, C. Mori, B. von Eisenhart Rothe, S. Pocock, et al.
Rationale and design of Ferinject(R) Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia
Eur J Heart Fail,
November 1, 2009;
11(11):
1084 - 1091.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Pascual-Figal, J. C. Bonaque, B. Redondo, C. Caro, S. Manzano-Fernandez, J. Sanchez-Mas, I. P. Garrido, and M. Valdes
Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients
Eur J Heart Fail,
September 1, 2009;
11(9):
840 - 846.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P van der Meer, H F Groenveld, J L Januzzi Jr, and D J van Veldhuisen
Erythropoietin treatment in patients with chronic heart failure: a meta-analysis
Heart,
August 15, 2009;
95(16):
1309 - 1314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Naito, T. Tsujino, M. Matsumoto, T. Sakoda, M. Ohyanagi, and T. Masuyama
Adaptive response of the heart to long-term anemia induced by iron deficiency
Am J Physiol Heart Circ Physiol,
March 1, 2009;
296(3):
H585 - H593.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. D. Pagourelias, C. Koumaras, A. I. Kakafika, K. Tziomalos, P. G. Zorou, V. G. Athyros, and A. Karagiannis
Cardiorenal Anemia Syndrome: Do Erythropoietin and Iron Therapy Have a Place in the Treatment of Heart Failure?
Angiology,
February 1, 2009;
60(1):
74 - 81.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. S. Silverberg, D. Wexler, A. Iaina, and D. Schwartz
The Role of Correction of Anemia in Patients With Congestive Heart Failure Associated with Chronic Kidney Failure
Journal of Pharmacy Practice,
December 1, 2008;
21(6):
420 - 423.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Adlbrecht, S. Kommata, M. Hulsmann, T. Szekeres, C. Bieglmayer, G. Strunk, G. Karanikas, R. Berger, D. Mortl, K. Kletter, et al.
Chronic heart failure leads to an expanded plasma volume and pseudoanaemia, but does not lead to a reduction in the body's red cell volume
Eur. Heart J.,
October 1, 2008;
29(19):
2343 - 2350.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur. Heart J.,
October 1, 2008;
29(19):
2388 - 2442.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur J Heart Fail,
October 1, 2008;
10(10):
933 - 989.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Silverberg, D. Wexlerb, A. Iaina, and D. Schwartz
The role of correction of anaemia in patients with congestive heart failure: A short review
Eur J Heart Fail,
September 1, 2008;
10(9):
819 - 823.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. S. Anand
Anemia and Chronic Heart Failure: Implications and Treatment Options
J. Am. Coll. Cardiol.,
August 12, 2008;
52(7):
501 - 511.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. O. Okonko, A. Grzeslo, T. Witkowski, A. K.J. Mandal, R. M. Slater, M. Roughton, G. Foldes, T. Thum, J. Majda, W. Banasiak, et al.
Effect of Intravenous Iron Sucrose on Exercise Tolerance in Anemic and Nonanemic Patients With Symptomatic Chronic Heart Failure and Iron Deficiency: FERRIC-HF: A Randomized, Controlled, Observer-Blinded Trial
J. Am. Coll. Cardiol.,
January 15, 2008;
51(2):
103 - 112.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Toblli, A. Lombrana, P. Duarte, and F. Di Gennaro
Intravenous Iron Reduces NT-Pro-Brain Natriuretic Peptide in Anemic Patients With Chronic Heart Failure and Renal Insufficiency
J. Am. Coll. Cardiol.,
October 23, 2007;
50(17):
1657 - 1665.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. S. Francis and A. Kanderian
Anemia and Heart Failure: A New Pathway?
J. Am. Coll. Cardiol.,
October 23, 2007;
50(17):
1666 - 1667.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. N. Nanas, C. Matsouka, and M. I. Anastasiou-Nana
Reply
J. Am. Coll. Cardiol.,
June 12, 2007;
49(23):
2302 - 2302.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Ezekowitz
Anemia in Patients With Advanced Heart Failure
J. Am. Coll. Cardiol.,
June 12, 2007;
49(23):
2301 - 2301.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. D. Westenbrink, A. A. Voors, and D. J. van Veldhuisen
Is Anemia in Chronic Heart Failure Caused by Iron Deficiency?
J. Am. Coll. Cardiol.,
June 12, 2007;
49(23):
2301 - 2302.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Dec
Anemia in Heart Failure: Time to Rethink Its Etiology and Treatment?
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2490 - 2492.
[Full Text]
[PDF]
|
|
|
|
