Complex Anemia in Tuberculosis: The Need to Consider Causes and Timing When Designing Interventions

Minchella, P.; Donkor, Simon; Owolabi, Olumuyiwa; Sutherland, Jayne S.; McDermid, Joann M.

doi:10.1093/cid/ciu945

Cited by 78 publications

(106 citation statements)

References 29 publications

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“…It should be noted that anemia in tuberculosis is mainly inflammatory anemia (anemia of inflammation or AI). Interestingly, this AI often resolves with TB treatment as previously reported [4] [5] [9]. Also, depending on whether HIV is also present or not, resolution of anemia was reported after ART treatment in TB-HIV+ patients [10].…”

Section: Introductionsupporting

confidence: 68%

“…Anemia is widely recognized as a common TB-associated morbidity [4] [5]. The prevalence of TB-associated anemia varies from 32% to 86% [5] [6] [7] and numerous causes have been invoked [8].…”

Section: Introductionmentioning

confidence: 99%

“…Also, depending on whether HIV is also present or not, resolution of anemia was reported after ART treatment in TB-HIV+ patients [10]. Of interest, patients with iron-responsive anemia (iron deficiency anemia (IDA), and multifactorial anemia (IDA + AI)) [4] [9] do not show spontaneous resolution of anemia with TB treatment. Rather, iron-responsive anemia in TB tends to recover quickly after 2 or 3 months of iron supplement in addition to TB treatment [4] [11].…”

Section: Introductionmentioning

confidence: 99%

“…Of interest, patients with iron-responsive anemia (iron deficiency anemia (IDA), and multifactorial anemia (IDA + AI)) [4] [9] do not show spontaneous resolution of anemia with TB treatment. Rather, iron-responsive anemia in TB tends to recover quickly after 2 or 3 months of iron supplement in addition to TB treatment [4] [11]. Based on the observation that anemia is generally multifactorial in Sub-Saharan Africa (SSA) [8], it can be speculated that majority of TB-patients would need iron supplement.…”

Section: Introductionmentioning

confidence: 99%

“…Caution is however warranted since iron-based intervention is not only unnecessary in AI, but can also cause iron overloading and be harmful, e.g. by increasing bacterial replication through shifting of Th1 to Th2 cytokine responses, and blocking the No-dependent bactericidal activity [4] [12]. Therefore, iron status biomarkers are important in determining the real need and efficiency for iron supplement.…”

Section: Introductionmentioning

confidence: 99%

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

Mulenga¹,

Kayembe²,

Kabengele³

et al. 2017

JTR

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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.

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Section: Introductionsupporting

confidence: 68%