Abstract 1889: Etiology of Anemia in Advanced Heart Failure
Background: Anemia is common in advanced congestive heart failure (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. We prospectively investigated the causes of anemia in patients with end-stage CHF.
Methods: Patients hospitalized with dilated cardiomyopathy and stabilized CHF 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 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 included 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” due to activation of inflammatory mechanisms. Serum ferritin (whose mean value was 75.3±59.1 ng/ml, [normal >17 ng/ml]) 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.