Anemia: Fast Facts (Peer reviewed publications)
Study Review NHANES III Data on Anemia Prevalence
Researchers assessed the third National Health and Nutrition Examination Survey (1988-1994) for anemia prevalence rates. The prevalence of anemia among men and women over the age of 65 years was 11.0% and 10.2%, respectively. One-third of the cases were classified as "anemia of chronic inflammation or chronic renal disease"; one-third was linked to nutrient deficiency, and the remaining third was attributed to unknown causes. The researchers concluded that anemia is a common condition in the elderly, although most cases were not severe, and the cause was unknown in a significant proportion.
Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004;104(8):2263-2268
Impact of Epoietin Alfa on Anemia and Quality of life
A systematic literature review, accompanied by a data meta-analysis, of the Cochrane Library and other data bases was conducted to assess the role of epoetin alfa in improving quality of life for anemia in oncology patients. The cohort consisted of 11,459 patients from 23 trials. Quality of life was measured in this population by measuring the Cancer Linear Assessment Score (CLAS), Functional Assessment of Cancer Therapy (FACT) scale, Eastern Cooperative Oncology Group (ECOG) scale, and/or Medical Outcomes Study Short-Form 36 (SF-36) scale. The research team concluded that epoetin alfa significantly improves quality of life based on improved CLAS (20-25%), FACT-Fatigue (17%), and FACT- anemia (12%). ECOG scores worsened for control cohorts (P=0.05), while four of the SF-36 subscales improved with administration of epoetin alfa.
Jones M, Schenkel B, Just J, Fallowfield L. Epoetin alfa improves quality of life in patients with cancer - Results of a meta-analysis. Cancer. 2004;101(8):1720-1732
Relationship Between Anemia and Declining Glomerular Filtration
Researchers investigated the relationship between anemia and glomerular filtration rates in patients with chronic kidney disease in a large-scale, cross-sectional, US multicenter survey of 5,222 patients. The prevalence of anemia in this population was inversely related to a declining glomerular filtration rate. Anemia was present in 47.7% of the study cohort. Diabetes, female sex, and race/ethnicity were predictors of anemia in the studied population, with anemia present in 47.7% of the study cohort.
NAAC commentary: There are associational data showing that the lower the hemoglobin, the more rapid the rate of decline of glomerular filtration rates; however, there are no interventional trials that have demonstrated raising the hemoglobin will slow the rate of progression.
McClellan, W; Aronoff, SL; Bolton, WK; Hood, S; Lorber, DL; Tang, KL; Tse, TF; Wasserman, B; Leiserowitz, M. The prevalence of anemia in patients with chronic kidney disease. Current Medical Research and Opinion. 2004; 20(9):1501-1510.
Anemia and Survival in HIV-Infected Women
A prospective multicenter study was conducted to evaluate the relationship between anemia (hemoglobin <12 g/dL) and overall survival in 2,056 HIV-infected women. Anemia was determined to be an independent risk factor for decreased survival in this population. The study found 47% of patients developed anemia by 3.5 years of follow-up. A multivariate analysis found that highly active anti-retroviral therapy (HAART) for a minimum of 6 months was associated with resolution of anemia; the protective effect of HAART against development of anemia was present 12 months or longer.
Berhane K, Karim R, Cohen MH, et al. Impact of highly active antiretroviral therapy on anemia and relationship between anemia and survival in a large cohort of HIV-infected women - Women's interagency HIV study. JAIDS. 2004;37(2):1245-1252
Small Bowel Biopsies in Patients with Iron Deficiency Anemia
Researchers assessed the role of routine small bowel biopsies in patients presenting with iron deficiency anemia in 103 consecutive cases with a diagnosis of iron deficiency anemia and laboratory values of ferritin <15 mg/L or iron saturation <8%. Celiac disease was diagnosed in 8.7% of the study cohort, and of these patients 33% had endoscopic lesions identified which were potentially responsible for the iron deficiency anemia. The research team concluded that routine small bowel biopsy to evaluate for celiac disease is indicated in patients with otherwise unexplained iron deficiency anemia.
Grisolano SW, Oxentenko AS, Murray JA, Burgart LJ, Dierkhising RA, Alexander JA. The usefulness of routine small bowel biopsies in evaluation of iron deficiency anemia. J Clin Gastr. 2004;38(9):756-760
Impact of Anemia on Hospital Length of Stay, Charges, and Hospital Mortality in Heart Failure Patients
A retrospective analysis was conducted on 8,569 heart failure patients in order to determine the impact of hemoglobin level on hospital length of stay, total charges, and hospital mortality. The study revealed that 40.2% of the patients with heart failure had anemia, and 73.8% of these patients were >70 years of age. Higher hemoglobin was associated with reductions in mortality, length of stay, and charges in hospitalized heart failure patients. It is not clear whether anemia alone is responsible for the above outcome, or whether the anemia is simply a surrogate for a sicker patient.
Nordyke RJ, Kim JJ, Goldberg GA, et al. Impact of anemia on hospitalization time, charges, and mortality in patients with heart failure. Value Health. 2004 Jul-Aug;7(4):464-71
Prevalence and Predictors of Anemia in Patients with Diabetes type I
An Australian study conducted on patients with diabetes confirmed that the prevalence of anemia is increased in patients with type 1 diabetes, and the presence of renal disease significantly increases the risk of anemia. Patients were six times more likely to have anemia with impaired renal function, and retinopathy and other nonvascular complications of diabetes were more common in patients with subnormal hemoglobin levels.
Thomas MC, MacIsaac RJ, Tsalamandris C, et al. Anemia in Patients with Type 1 Diabetes. J Clin Endocrinol Metab. 2004;89(9):4359-63
Hepcidin and Iron Regulation
A study evaluating the role of hepcidin on iron regulation found that decreased export of cellular iron was attributed to an internalization of ferroportin following the binding of hepcidin to ferroportin in tissue culture cells. The research team suggested that the post-translational regulation of ferroportin by hepcidin may complete a homeostatic loop which controls the concentration of ferroportin on cellular surfaces.
Nemeth E, Tuttle MS, Powelson J, et al. Hepcidin Regulates Iron Efflux by Binding to Ferroportin and Inducing Its Internalization. Science. 2004 Oct 28;
Prevalence of Anemia in Portuguese FAP type I Patients
A retrospective cross-sectional study was conducted on 165 Portuguese patients with familial amyloid polyneuropathy type I (FAP type I) in order to measure anemia prevalence in this population, and evaluate how endogenous erythropoietin production is related to the anemia. The study revealed 24.8% of the patient population was anemic, with normal iron stores, vitamin B12, and serum folate levels. The research team concluded a defect in endogenous erythropoietin production was the primary etiologic factor in FAP type I patients with anemia.
Beirao I, Lobato L, Costa PM. Kidney and anemia in familial amyloidosis type I. Kidney Int. 2004;66(5):2004-9.
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