Abstract 13729: Iron Deficiency, Determined by Absence of Iron in the Bone Marrow, is the most Common Cause of Anemia in Heart Failure, Irrespective of Disease Severity
Background: Anemia is a major co-morbidity in heart failure (HF) with adverse prognostic implications, however its etiology remains controversial. Iron deficiency is highly prevalent in advanced stages, but its importance in less symptomatic patients remains uncertain. In the present study we investigated anemia etiology in HF using a thorough array of laboratory tests, including bone marrow aspiration.
Methods: Ninety four consecutive patients (age 59±12 yrs) with HF and anemia were enrolled. Anemia was defined as a haemoglobin (Hb) concentration < 12g/dl in men and 3 mg/dl or with diseases known to cause anemia were excluded. All patients underwent bone marrow aspiration for iron store assessment, serum iron and ferritin determination and if those tests were inconclusive, red blood cell mass measurement with 51Cr .
Results: Mean serum Hb was 10.8±0.9gr/dl for the whole cohort. Hb was 11.5±0.7gr/dl , 11±1 gr/dl and 10±0.9gr/dl in NYHA II, III and IV patients, respectively. Iron deficiency (confirmed by bone marrow aspiration) was present in 67 patients (71%), 5 patients (5.3%) had dilutional anemia and 2 patients (2.1%) had drug-induced anemia. No specific cause was identified in 20 patients (21.2%) who were considered to have anemia of chronic disease. Prevalence of iron deficiency increased from 57% in NYHA II patients to 75% in NYHA IV. Serum ferritin was 162±150 ng/ml, serum iron 58±26ng/ml and MCV 84±9fl in the complete patient cohort, 99 ±85, 57±27 and 82± 8, respectively, in iron-deficient patients, and 234± 123 (P=0.000 vs iron deficient pts), 61±26 and 87± 8 in the non-iron deficient patients. ROC curve analysis showed that ferritin could identify iron deficient patients (area 0.819, P=0.000). A ferritin value > 153ng/ml ruled out iron deficiency with a sensitivity of 71% and specificity of 83%.
Conclusions: Iron deficiency, identified by the gold standard technique of bone marrow aspiration, is the most common cause of anemia in HF, irrespective of disease stage. Traditional serum markers are unreliable in this setting, with the exception of ferritin, however modified cut off values have to be applied. Iron deficiency may represent an important treatment target in heart failure patients.
- © 2010 by American Heart Association, Inc.