Summary:
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 B(12),
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
(51)Cr 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.
Keywords:
Anemia, Heart failure, Iron deficiency, Anemia of chronic disease, Hemodilution
