title: Chronic heart failure leads to an expanded plasma volume and pseudoanaemia, but does not lead to a reduction in the body's red cell volume.
abstract: Aims Chronic heart failure (CHF) is frequently associated with a decreased haemoglobin level, whereas the mechanism remains largely unknown. Methods and results One hundred consecutive CHF patients without anaemia or renal dysfunction based on non-cardiac reasons were enrolled. We explored determinants of anaemia (as iron parameters, erythropoietin, hepcidin and kidney function) including red cell volume (RCV) (by a 51 Cr assay) as well as related markers and plasma volume. The influence of each factor on haemoglobin concentrations was determined in a multiple regression model. Mean haemoglobin concentrations were 11.7 +/- 0.8 mg/dL in anaemic CHF patients and 14.4 +/- 1.2 mg/dL in non-anaemic patients. Corrected reticulocytes were lower in anaemic patients (35.1 +/- 15.7 vs. 50.3 +/- 19.2 G/L, P = 0.001), but the RCV was not reduced (1659.3 +/- 517.6 vs. 1826.4 +/- 641.3 mL, P = 0.194). We found that plasma volumes were significantly higher in anaemic CHF patients (70.0 +/- 2.4 vs. 65.0 +/- 4.0%, P < 0.001). Plasma volume was the best predictor of haemoglobin concentrations in the regression model applied (B = -0.651, P < 0.001, R(2) = 0.769). Conclusion Haemodilution appears to be the most potent factor for the development of low haemoglobin levels in patients with CHF. Our data support an additional independent, but minor influence of iron deficiency on haemoglobin concentrations in CHF patients.
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Christopher
authors.initials: C
authors.lastname: Adlbrecht
authors.forename: Spyridoula
authors.initials: S
authors.lastname: Kommata
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Szekeres
authors.forename: Christian
authors.initials: C
authors.lastname: Bieglmayer
authors.forename: Guido
authors.initials: G
authors.lastname: Strunk
authors.forename: Georgios
authors.initials: G
authors.lastname: Karanikas
authors.forename: Rudolf
authors.initials: R
authors.lastname: Berger
authors.forename: Deddo
authors.initials: D
authors.lastname: Mörtl
authors.forename: Kurt
authors.initials: K
authors.lastname: Kletter
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000209:etiology*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004911:Erythrocyte Volume; D004921:Erythropoietin / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000097:blood; D008297:Male; D008875:Middle Aged; D010953:Plasma Volume / Q000502:physiology
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin; D007501:Iron