title: Anemia in ST-Elevation Myocardial Infarction Patients with Markers of Inadequate Bone Marrow Response.
abstract: BACKGROUND
  Anemia confers an adverse prognosis in patients with ST-elevation myocardial infarction (STEMI). Several mechanisms have been implicated in the etiology of anemia in this setting, including inflammation, blood loss, and the presence of comorbidities such as renal failure.
  
  
  OBJECTIVE
  To evaluate the adequacy of bone marrow response as potentially reflected by elevation in blood and reticulocyte counts.
  
  
  METHODS
  Consecutive men with STEMI who underwent primary percutaneous intervention within 6 hours of symptom onset and who presented to our catheterization laboratory during a 36 month period were included in the study. The cohort was divided into quartiles according to hemoglobin concentration, and differences in clinical and laboratory characteristics between the groups were evaluated.
  
  
  RESULTS
  A total of 258 men with STEMI were recruited, 22% of whom suffered from anemia according to the World Health Organization classification (hemoglobin < 13 g/dl). Men in the lowest quartile of hemoglobin concentration presented with significantly lower white blood cell and platelet counts (9.6 ± 2.9 vs. 12.6 ± 3.6 x 103/μl, P < 0.001) and (231 ± 79 vs. 263 ± 8 x 103/μl, P < 0.01), respectively, despite higher inflammatory biomarkers (C-reactive protein and fibrinogen) compared with patients in the upper hemoglobin concentration quartile. Reticulocyte production index was not significantly higher in anemic patients, with a value of 1.8, 1.4, 1.5 and 1.6 in the ascending hemoglobin quartiles, respectively (P = 0.292).
  
  
  CONCLUSIONS
  Anemic men with STEMI have relatively lower leukocyte and platelet counts as well as a reduced reticulocyte count despite higher inflammatory biomarkers. These findings might suggest inadequate bone marrow response.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Arbel
authors.forename: Assi
authors.initials: A
authors.lastname: Milwidsky
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.forename: Amir
authors.initials: A
authors.lastname: Halkin
authors.forename: Miri
authors.initials: M
authors.lastname: Revivo
authors.forename: Shlomo
authors.initials: S
authors.lastname: Berliner
authors.forename: Martin
authors.initials: M
authors.lastname: Ellis
authors.forename: Itzhak
authors.initials: I
authors.lastname: Herz
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D001772:Blood Cell Count / Q000379:methods; D001853:Bone Marrow / Q000378:metabolism / Q000503:physiopathology; D002097:C-Reactive Protein / Q000032:analysis; D004562:Electrocardiography; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000097:blood*; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011379:Prognosis; D012042:Registries; D012156:Reticulocytes
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D002097:C-Reactive Protein