Chest
Volume 127, Issue 3, March 2005, Pages 825-829
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Clinical Investigations: COPD
Anemia and Inflammation in COPD

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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

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