Anemia and Hematologic Characteristics in Newly Diagnosed Pulmonary Tuberculosis Patients at Diagnosis in Kinshasa

Abstract

Context: The burden of TB in Africa tends to be exacerbated by the socio-economic situation and the high prevalence of intercurrent infections such as HIV, malaria and non-specific bacterial infections. These factors often result in anemia, making patients at high risk for anemia. Objective: We aimed to gain insights into the characteristics of anemia, hematologic variations and socio-economic status in untreated pulmonary TB patients (PTB) in Kinshasa, the Democratic Republic of Congo. Methods: We conducted a cross-sectional analysis of 200 smear-positive pulmonary TB patients (PTB) recruited at the initiation of TB treatment. Complete Blood Count, Iron profile, BMI, CRP and albuminemia were assessed. Data were analyzed using Student t or Mann Whitney tests as appropriate, and logistic regression was performed to assess the strength of associations. Results: Anemia was a regular finding in (69%). This anemia was mostly moderate (92.2%) and with iron deficiency pattern (48%). Hypoalbuminemia was observed in half of the subjects and appears to be correlated with the severity of anemia. Surprisingly, the severity of inflammation, as reflected by the CRP, was inversely correlated with the anemia. In the multivariate analysis, alcohol intake (OR: 2.38; IC 95%: 1.05 -5.38), hypoalbuminemia (OR: 1.98; IC 95%: 1.02 -3.82) and CRP rate were significantly associated with the presence of anemia among pulmonary tuberculosis at the diagnostic. Conclusion: This study demonstrates the heavy burden of the iron responsive anemia and risky life conditions in newly diagnosed TB patients, and underscores the potential usefulness of iron supplementation in the Congolese context.

Anemia in tuberculosis cases: A biomarker of severity?

“…We found a prevalence of anemia similar to those observed in studies carried out in Asia [ 7 ] and Africa [ 5 , 11 , 13 , 15 , 23 ]. However, Lee et al showed a lower prevalence of anemia in South Korea (31.9%).…”

“…We observed that conditions predicting nutritional deficiency (such as low BMI, history of weight loss, and low albumin levels) were more frequent in anemic than in nonanemic patients, and C-reactive protein, a marker of an active inflammatory process, was significantly higher in patients with anemia. Other studies have also shown an association of anemia with hypoalbuminemia [ 17 , 23 ], increased C-reactive protein [ 7 , 17 , 23 ] and decreased BMI [ 8 , 15 , 16 ]. These observations, together with the evidence of decreased MCH and MCV in patients with anemia and the significant prevalence of microcytic hypochromic anemia (27.8% of anemia cases), allow us to speculate that important causes of anemia in TB patients may be iron nutritional deficiency and/or its decreased availability to erythropoiesis due to alterations of its metabolism in inflammation.…”

Prevalence and types of anemia among people with tuberculosis in Africa: a systematic review and meta-analysis

“…Moreover, macrocytic anemia is often identified in less than 10% of patients at the time of diagnosis of TB 18 . Normocytic hypochromic picture is also reported in studies with a variable frequency, including 32.5% in Ethiopia 23 , 47.5% in the Democratic Republic of Congo 24 . It is noted that the observed variation might be associated to the impact of HIV/AIDS and the differences in the cutoff values used to define the morphological pattern of anemia.…”

Hematological manifestations in patients newly diagnosed with pulmonary tuberculosis

“…16 Mulenga reported anemia in 69% of cases and it was moderate in 92% of cases; iron deficiency anemia was predominant type and he showed that hypoalbuminemia, alcohol intake and C-reactive protein (CRP) had an effect on anemia. 17 Kulkarni in 2017 also reported IDA as the predominant type and anemia was seen in 69.2% of cases and mostly it was mild. 18…”