Chest
Volume 127, Issue 3, March 2005, Pages 825-829
Journal home page for Chest

Clinical Investigations: COPD
Anemia and Inflammation in COPD

https://doi.org/10.1378/chest.127.3.825Get rights and content

Background

Anemia in patients with COPD and its pathophysiology is an understudied issue

Methods

In a group of 101 COPD patients (FEV1 percentage of predicted, 37 ± 2% [mean ± SEM]; mean age, 61 ± 1 years; 35% female gender), the prevalence of anemia and its relationship to body mass and weight loss, inflammatory parameters, and erythropoietin levels was determined. Data were compared to a control group (healthy persons with matched age) in order to identify potential factors that may influence the development of anemia in patients with COPD

Results

Anemia was diagnosed in 13 patients (hemoglobin levels < 13.5 mg/dL in male patients and < 12.0 mg/dL in female patients), which represents a prevalence of 13%. Anemic COPD patients showed elevated erythropoietin levels (41.8 ± 25.4 U/L vs 16.3 ± 2.9 U/L) and an increased inflammatory response compared to nonanemic patients. A significant inverse correlation of hemoglobin vs erythropoietin (r = − 0.84, p < 0.01) was observed in anemic COPD patients, but not in the nonanemic group

Conclusion

Anemic COPD patients show high erythropoietin levels, which may indicate presence of erythropoietin resistance. The latter may be mediated through inflammatory mechanisms, which is typical for anemia of chronic illness

Section snippets

Patient Population

We recruited 101 patients (mean age [± SEM], 60.8 ± 1.2 years; 35 women and 66 men) with COPD diagnosed according to the guidelines of the American Thoracic Society.5 All patients showed an FEV1 reversibility of < 9% in response to inhaled bronchodilators. In this population, 21 were smokers, 75 were ex-smokers, and 5 were nonsmokers (> 5 years of smoking cessation). Grading the disease severity revealed that 23 patients had mild COPD, 36 patients had moderate COPD, and 42 patients had severe

Prevalence and Characteristics of Anemia

According to the definition of anemia in this study (hemoglobin concentration in men < 13.5 mg/dL; hemoglobin concentration in women < 12.0 mg/dL), 13 of 101 COPD patients were anemic, which represents a prevalence of anemia of 13%. Anemia appeared as normochromic and normocytic. In a subgroup of nine anemic patients, erythropoietin was measured and appeared to be higher in the anemic group compared to nonanemic COPD patients and normal control subjects (p < 0.05) [Table 1]

Characteristic of Anemic and Nonanemic COPD Patients in Comparison to Normal Control Subjects

The main

Discussion

This study documents that anemia occurs relatively frequently in COPD patients and is related to the presence of inflammation. Anemia is an understudied issue in COPD but may be of great importance in this disease. In our cohort, anemia (with hemoglobin concentrations < 12.0 g/dL in women and < 13.5 g/dL in men) was present in as many as 13% of all COPD patients. This may be an underestimation of the anemia prevalence, as we have excluded patients with anemia related to bleeding and known

References (13)

There are more references available in the full text version of this article.

Cited by (146)

  • A hypoxia-driven occurrence of chronic kidney disease and osteoporosis in COPD individuals: New insights into environmental cadmium exposure

    2022, Toxicology
    Citation Excerpt :

    Anemia would then further deepen hypoxia and subsequent cadmium accumulation, which already has the potential to manifest due to COPD. In COPD individuals, anemia can be mediated by inflammatory cytokines (John et al., 2005); nevertheless, iron deficiency-induced anemia may also occur. Independent to COPD, iron deficiency occurring due to the lack of ferroportin (because of existing inflammation as discussed) causes additional expression of DMT-1 (Gunshin et al., 1997; Yeh et al., 2000).

  • The role of iron in chronic inflammatory diseases: from mechanisms to treatment options in anemia of inflammation

    2022, Blood
    Citation Excerpt :

    Importantly, it is essential to provide a good diagnostic workup of the causes of anemia in COPD because treatment strategies and efficacy may differ according to the presence of absolute or functional iron deficiency or other coexisting pathologies affecting erythropoiesis.139 Accordingly, treatment failure in a subgroup of patients with COPD may be explained by EPO resistance or iron trapping in macrophages as a consequence of inflammation.134,140 CHF is a chronic progressive condition in which the heart cannot pump enough blood to meet the body’s requirements.

  • Anemia in chronic obstructive pulmonary disease: A systematic review

    2022, Respiratory Investigation
    Citation Excerpt :

    Evaluating the EPO level in response to anemia is the next step in treatment. Despite the increasing EPO levels in COPD, some researchers have shown resistance to EPO [5,6,35,42]. In this regard, Schonhofer et al., in a clinical trial study, compared 10 COPD patients with 10 anemic patients but without lung dysfunction.

View all citing articles on Scopus
View full text