Abstract 14653: A Simple Diagnostic and Therapeutic Algorithm For Anemia in End Stage Heart Failure Patients
Anemia is a common co-morbidity in Heart Failure (HF) with multifactorial etiology. Indications about optimal treatment regimen (ESA, iron or both) currently do not exist.
Purpose: To find a practical diagnostic algorithm with therapeutic implications for anemia in advanced HF, based on laboratory tests easily performed in daily practice.
Methods: We evaluated 101 consecutive patients with end stage HF (EF 26.3 ± 6.5%, NYHA 3.5±0.6) and anemia (Hgb < 13gr/dl in men and < 12gr/dl in postmenopausal women). Patients with diseases known to cause anemia or creatinine > 3mg/dl were excluded. All patients underwent complete diagnostic work-up including bone-marrow aspiration for iron store assessment. Anemia was attributed to chronic inflammation when bone marrow was compatible and no other specific cause was identified.
Results: Hemoglobin, MCV, MCH and ferritin values were 10.8 ± 1.1 gr/dl, 84.9±8.9 μ m3, 27.3±3.8 fmol/cell and 157.5±160.2 ng/ml, respectively (mean ± SD). Iron-deficiency (ID-absence of iron in bone marrow) was the cause of anemia in 72.3 % of patients, chronic inflammation in 20.5%, hemodilution in 3.9% and drug toxicity in 2.9 %. All patients with MCH < 20 fmol/cell (5/101) were truly iron deficient and could be treated with iron, based on this simple test alone. MCH >20 fmol/cell and ferritin <150 ng/ml identified iron deficient pts with sensitivity of 82.3%, specificity of 75% and positive predictive value of 88.8%. This means that 63/101 (62%), including 7 without ID, will receive iron. Patients with MCH > 20 fmol/cell and ferritin > 150 ng/ml can be diagnosed as non-iron deficient. This approach would result in overtreatment of 36% of these patients (12/33), since they would be treated with ESA although iron deficiency is the cause of their anemia.
Conclusions: A diagnostic algorithm based on easily performed laboratory tests can provide a practical, valid and rapid evaluation of anemia etiology in patients with HF, with acceptable rates of misclassifications. This approach negates the need for bone marrow aspiration and can guide effectively decisions concerning treatment
- © 2011 by American Heart Association, Inc.