Journal reading

Anemia and iron defciency in

COPD patients: prevalence
and the efects of correction
of the anemia with
erythropoiesis stimulating
agents and intravenous iron
dr. Desilia Atikawati
Prof. Dr. dr. . !. "gurah #ai$ %p.P&'(
Donald S Silverberg, Ram Mor, Melanie Tia Weu, Doron
Schwartz, Idit F Schwartz and Gil Chernin
ac!ground

"nemia #$%&$' o( C)*D +atient,-

",,ociated with increa,ed mortalit. and morbidit.-

"nemia negative e/ect on0

D.,+nea and wal!ing di,tance-

Circulator. e1cienc. lower +ea! o2.gen u+ta!e

and lower +ea! wor! rate, with the need (or home
o2.gen thera+. and lower mean +eri+heral o2.gen
value, both at re,t and during e2erci,e

C)*D increa,ed c.to!ine +roduction anemia

and iron de3cienc.-
ID0 iron de3cienc.
Method,
%tudy )

4o,+ital record, o( all

+atient, admitted with
an "5C)*D between Jan
#
,t
6$#6 % Dec &#
,t
6$#6-

",,e,, the +revalence,

the inve,tigation and
treatment o( anemia
and ID-
%tudy *

#6 anemic 74b 8 #6g9dl: +atient,

with an e,tabli,hed diagno,i, o(
C)*D-

"nal.zed the e/ect, o( the

combination o( ,ubcutaneou,
5S", and I;%iron on d.,+nea-

*atient characteri,tic, that were

e2amined at ba,eline included
+re,ence o( C<D, C4F,
h.+erten,ion, diabete,,
d.,li+idemia and the medication,
ta!en-
5S",0 5r.thro+oie,i, Stimulating
"gent,

The anemia wa, corrected with the combination o( 5S",

and I;%iron given once wee!l. (or = wee!,-

The 3nal a,,e,,ment wa, done one wee! a(ter the la,t
do,e-

+ iron 76$$ mg o( elemental iron:0

Given a, two = ml am+oule, % > #$$ mg o( elemental iron-

The do,e, were given one wee! a+art 7a total o( #$$$ mg

elemental iron: (or = wee!,-

5S",0

Given wee!l. in the (orm o( #$,$$$ I? o( ,ubcutaneou, 7,c: (or =

wee!, at the ,ame time that the I; iron wa, given-

Weight, height, and blood +re,,ure were mea,ured on ever.

wee!l. vi,it-

lood wor!, done initiall., at ever. vi,it and one wee! a(ter
the =
th
treatment, included0

4b, 4ct, RC, and RC indice,, Red Cell Di,tribution Width 7RDW:,
+latelet,, ,erum iron, Tran,(errin, +ercent tran,(errin ,aturation
7'T,at:, ,erum (erritin, albumin, SG)T, SG*T, ,erum creatinine-

De3nition, (or ID & di/erent criteria0

Serum (erritin o( 8#$$ ng9ml,

'TSat 86$', or

5ither a ,erum (erritin o( 8#$$ ng9ml or the combination o(

,erum (erritin o( #$$%&$$ ng9ml and'TSat o( 86$'-

*ulmonar. (unction +er(ormed b. ,+irometr.-

F5; #, F;C, and the F5;#9F;C all a,,e,,ed a, +ercent o(

+redicted value,-

Mea,ured be(ore 5*)%I; iron thera+.-

4ealth +erce+tion a,,e,,ed at ba,eline and one wee!

a(ter the 3(th in@ection o( 5*) and I; iron-

?,ing a ;i,ual "nalog Scale 7;"S: ma!ing a line #$ cm in

length-

" ,core o( $ e2tremel. ,evere d.,+nea on wal!ing a ,hort

di,tance or at re,t-

" ,core o( #$ no d.,+nea on wal!ing or at re,t-

The +atient +laced an A on what the. con,idered their current

,tatu, be(ore and # wee! a(ter the la,t do,e o( the
combination treatment-
Re,ult,
%tudy ) % *revalence o( anemia and iron de3cienc. in
+atient, ho,+italized with "5C)*D

)( #$B +atient, admitted with "5C)*D, ,- patients

7C&-D': were (ound to be anemic on admi,,ion 74b 8 #6
g9dl:-

ID 7,erum iron, 'TSat and ,erum (erritin wa, (ound in ).

7&E-&': o( the CB anemic +atient, 7com+ared to onl. 6
7&-&': o( the F$ non%anemic +atient,:-
%tudy * % )ut+atient,
intervention ,tud.

!aseline assessment

#ed cell indices

The anemia wa, normoc.tic and normochromic in all, with normal

mean value, (or MC4, MC; and MC4C-

The mean RDW wa, increa,ed-

Prevalence of iron defciency

i( de3ned a, onl. a ,erum (erritin o( 8#$$ ng9ml F9#6 7=$':-

I( de3ned onl. a, 'TSat 86$' D9#6 7B=':-

I( de3ned a, the combination o( ,erum (erritin o( 8&$$ ng9ml and

'TSat o( 86$' D9#6 7B=':-

I( de3ned 7a, we de3ned it: a, either a ,erum (erritin o(8#$$

ng9ml or the combination o( ,erum (erritin o( #$$%&$$ ng9ml and
'TSat o( 86$' ##9#6 7D#-F': o( the ca,e,-

#esults of treatment / 0emoglo1in and red cell

indices

The 01 rose (rom an initial median o( D-D g9dl GD-6%#$-FH to

#6-&= g9dl G##-F%#&-$H 7+ I $-$$$=: b. one wee! a(ter the la,t
in@ection-

The 0ct similarly increased (rom 6D-D' G6E-$%&#-=H to

&E-#' G&=-$%&D-CH 7+I$-$$$=:-

The median RC count increa,ed (rom &-& cell,9mcJ G&-6%&-BH

to &-D cell,9mcJ G&-F%C-&H 7+ I $-$#:

ron indices

The serum ferritin and 23%at increased

signifcantly b. one wee! a(ter the la,t do,e
ver,u, ba,eline-

Serum (erritin (rom DD ng9ml GCE-F%#6B-CH to &&$-F

ng9ml G6C&-C% F#=-6H 7+I$-$$=: and 'TSat (rom
#6-E' G##K#D-#H to 6C-$' G#E-=%6B-DH 7+ I $-$$=:

Other 1lood parameter

The change, in the RDW,

WC, l.m+hoc.te, and
+latelet, were not ,igni3cant-

0emoglo1in and 0ematocrit correction and

improvement of dyspnea

The +A% scale increased (rom an initial 6-= G6K&H to E-= GBK
#$H 7+ I $-$$$=:-

There wa, a highly signifcant correlation 1etween the

401 and 4+A%L r, I $-B# + I $-$$D and between the 40ct
and 4+A%L r, I $-E + I $-$$#C
Di,cu,,ion

It wa, ,ugge,ted that the +revalence o( anemia i, li!el. higher

in ,evere C)*D com+ared to the general C)*D +o+ulation-

There are ,carce data about ID in C)*D-

Comeche Ca,anova et al a cohort o( #&$ +atient, with ,table

C)*D0 ,erum iron wa, ,igni3cantl. lower in anemic +atient,
than in tho,e without anemia-

" ,mall retro,+ective ,tud. in anemic out+atient, with

moderate to ,evere C)*D treatment with 5%A and +/
iron ,igni3cantl. im+roved the anemia and ID a,,ociated
with a signifcant improvement in ,el(%a,,e,,ed shortness
of 1reath-

The im+rovement in the ;"S d.,+nea ,core wa, directl.

related to the increa,e in 4b and 4ct-

The,e re,ult, are con,i,tent with the 3nding, o( other,

who treated anemia in C)*D with either anabolic
,teroid, or blood tran,(u,ion,-

"nemia in +atient, with C)*D i, li!el. due to0

5levated c.to!ine, level,, e,+eciall. TMF N and IJ%F

reduced +roduction o( 5*), reduced er.thro+oietic re,+on,e
o( the bone marrow to 5*), he+cidin%induced (ailure o( iron
ab,or+tion (rom the gut, and he+cidin%induced tra++ing o(
iron in iron ,tore, in the macro+hage, and he+atoc.te,-

Concomitant C<D with reduced +roduction 5*)-

?,e o( "C5%I and "R, that can cau,e reduced activit. o(

5*) in the bone marrow-

Concomitant Diabete, Mellitu,-

Ga,trointe,tinal cau,e,, e,+eciall. with u,e o( ,teroid,-

?S Third M4"M5S0 direct correlation between +ulmonar.

(unction 7F5;#: and the iron ,tatu, 7'TSat and (erritin:
reduced +ulmonar. (unction ma. be commonl.
a,,ociated with ID-
NHANES: National Health and Nutrition Examination survey

The role o( 5S", alone in C4F i, ,till uncertain

concern, about com+lication, related to 5S", thera+.
it, u,e in renal (ailure ha, been a,,ociated with an
increa,e in cardiova,cular and thromboembolic
+henomena, e,+eciall. when given in high do,e-
Stud. Jimitation,

" non%randomized, retro,+ective ob,ervation in a ,ingle

medical center-

In ,tud. 6 the +atient, had a ver. high rate o(

comorbiditie, including C<D, C4F, diabete, and
h.+erten,ion all #6 +atient, had C<D itO, +o,,ible
that C<D +redominated over their other comorbiditie,-

Did not ,tud. +ulmonar. (unction at the termination o( the

treatment +eriod unable to a,,e,, the e/ect o( anemia
correction on lung (unction-

For +atient, with C)*D +re(erred to u,e the Modi3ed

Medical Re,earch Council D.,+nea Scale 7mMRC: than ;"S
,cale-
Conclu,ion,

ID i, common in ho,+italized C)*D but generall. not

,ought a(ter and, i( (ound, generall. not treated-

Correction o( the ID in C)*D +atient, with 5S", and I;

iron can im+rove the anemia, the ID, and ma. im+rove
the d.,+nea-
Than! Pou