Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure.
OBJECTIVE
Anaemia is often observed in patients with chronic heart failure (CHF), and it may be associated with a worse prognosis. Aim of this study was to identify the individual mechanisms of anaemia in CHF patients.


RESULTS
One hundred and forty-eight consecutive patients with haemoglobin concentration <13 g/dL (if males) or <12 g/dL (if females) were enrolled. Factors responsible for anaemia were investigated by evaluating endogenous erythropoietin (Epo) production, serum cytokines levels, body iron status, and iron supply for erythropoiesis. Most patients (57%) presented anaemia of chronic disease and among them, 92% showed evidence of a defective endogenous Epo production. This was indicated by an observed/predicted log(serum Epo) ratio less than 0.8 and/or a defective iron supply for erythropoiesis diagnosed by low transferrin saturation and/or increased value of soluble transferrin receptor. According to regression analysis sex, renal failure, and serum Epo were correlated with anaemia.


CONCLUSIONS
According to our study, about half of anaemic CHF patients showed anaemia of chronic disease with blunted endogenous Epo production and/or a defective iron supply for erythropoiesis. Determination of the individual mechanisms of anaemia in CHF could justify a rational therapeutic approach to anaemia.
Department of Cardiology, Institute of Pavia, IRCCS Fondazione Salvatore Maugeri, Strada Ferrata 8, 27100 Pavia, Italy. copasich@fsm.it
Cristina
C
Opasich
Mario
M
Cazzola
Laura
L
Scelsi
Stefania
S
De Feo
Enzo
E
Bosimini
Rocco
R
Lagioia
Oreste
O
Febo
Roberto
R
Ferrari
Alessandro
A
Fucili
Remigio
R
Moratti
Roberto
R
Tramarin
Luigi
L
Tavazzi
D000740:Anemia / Q000209:etiology*; D002908:Chronic Disease; D016207:Cytokines / Q000378:metabolism; D004920:Erythropoiesis / Q000502:physiology*; D004921:Erythropoietin / Q000172:deficiency*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications*; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D011990:Receptors, Transferrin / Q000378:metabolism
D016207:Cytokines; D011990:Receptors, Transferrin; D004921:Erythropoietin