Abstract 2364: Chronic Heart Failure Leads to an Expanded Plasma Volume and Pseudoanemia, but Does Not Lead to a Reduction in the Body’s Red Cell Mass
Chronic heart failure (CHF) is frequently associated with a decreased hemoglobin level. Although in some patients renal anemia may develop, the mechanisms underlying the decrease in hemoglobin in isolated CHF remain largely unknown. We explored robust determinants of anemia including red cell mass as well as related markers and the plasma volume in patients with CHF without renal dysfunction based on non-cardiac reasons. One-hundred consecutive CHF patients were enrolled. The total red cell volume (RCV) was determined by a 51Cr assay. Furthermore, serum ferritin, erythropoietin, hepcidin, and renal function parameters were assessed. The influence of each factor on hemoglobin concentrations was determined in a multiple regression model. Mean hemoglobin concentrations were 11.7 ± 0.8mg/dL in anemic CHF patients and 14.4 ± 1.2mg/dL in non-anemic patients (p < 0.001). However, the RCV was not reduced (1659.3 ± 517.6mL versus 1826.4 ± 641.3mL, p = 0.194). There was no severe deficiency of iron or erythropoietin detectable in CHF patients but corrected reticulocytes were lower in anemic patients (35.1 ± 15.7G/L versus 50.3 ± 19.2G/L, p = 0.001). We found that plasma volume levels were significantly higher in anemic CHF patients, suggesting the presence of pseudoanemia (70.0 ± 2.4% versus 65.0 ± 4.0%, p < 0.001). Correspondingly, plasma volume was the best predictor of hemoglobin concentrations in the regression model applied (B = − 0.651, p < 0.001, R2 = 0.769). Hemodilution appears to be the most potent factor for the development of low hemoglobin levels in patients with a broad spectrum of severity of heart failure. Our data support an additional independent, but minor influence of iron deficiency on lower than normal hemoglobin concentrations in CHF patients. The study results support not administering erythropoiesis stimulating agents to unselected CHF patients with lower than normal hemoglobin levels.