Hypocholesterolemia in chronic anemias with increased erythropoietic activity

Abstract

Hypocholesterolemia of unknown etiology has been previously described in various chronic anemias. Few small studies also suggested that those patients have a lower incidence of atherosclerotic events. The aim of our study was to determine the extent of hypocholesterolemia in various types of anemias. We studied 59 patients with chronic anemias associated with higherythropoietic activity (thalassemia intermedia, congenital dyserythropoietic anemia type I, congenital spherocytosis), 8 patients with low-erythropoietic activity anemias (acquired aplastic anemia, Fanconi anemia, and Diamond Blackfan anemia), and 20 healthy controls. Mean serum cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, hemoglobin, serum ferritin, soluble transferrin receptor (STR), and serum erythropoietin levels were determined in each patient. All patients with chronic anemia and increased erythropoietic activity had hypocholesterolemia, whereas none of those with low erythropoietic activity was hypocholesterolemic. Mean serum cholesterol, HDL cholesterol, and LDL cholesterol levels were found to be significantly lower in the high-erythropoietic activity group (80 ± 19 mg/dl; 31 ± 10 mg/dl; 35 ± 14 mg/dl, respectively) compared with the control group (P < 0.001; 0.001; 0.001, respectively) and the low-erythropoietic activity group (P < 0.001; 0.001; 0.01, respectively). Significant inverse correlation (R 2 = 0.507) was observed between serum cholesterol and STR levels, which in the absence of iron deficiency reflect bone marrow activity. Taken together, our results imply that hypocholesterolemia accompanies anemias with high-erythropoietic activity. We suggest that the high-erythropoitic activity-associated hypocholesterolemia is due to increased cholesterol requirements by the proliferating erythoid cells. Further studies are needed to elucidate the exact mechanism and the possible clinical consequences of this phenomenon. Am. J. Hematol. 82:199-202, 2007. V V C 2006 WileyLiss, Inc.

Correlates of Steady State Lipid Profile and Anthropometric Parameters in Adult Sickle Cell Anaemia Patients in South-West Nigeria

“…17, It was observed that even though the means of these values were lower than that of the controls, it was still within normal reference interval (2.5-6.5 mmol/l; Table 1). Contrary to previous reports [3][4][5][6]20 only one in five of these patients (20%) had significant hypocholesterolaemia (TC <2.59 mmol/l). The hypocholesterolaemia may be a consequence of increased cholesterol utilization and/or decreased endogenous production.…”

“…Hypocholesterolaemia has been described in various anaemias with high erythropoietic activity [1][2][3][4][5][6][7] . In Nigerian children with sickle cell anaemia (SCA) and African-American patients with sickle cell disorder a significant reduction in plasma cholesterol; high density lipoprotein (HDL-c) and low density lipoprotein (LDLc) cholesterol concentration compared to normal controls have been reported 2,3 A study on adult with SCA reported low serum total cholesterol, LDL, HDL as well as lowered BMI compared to their controls.…”

“…Literature reports of postmortem examinations on SCA patients confirmed the scarcity of coronary artherosclerosis and myocardial infarction. 10 Defective lipid in sickle cell anaemia has been attributed to increased cholesterol utilization consequent to increased erythropoiesis as there is ongoing haemolysis as well as compensation by bone marrow 4 , however the pathogenesis is yet to be fully elucidated. Abnormal long chain polyunsaturated (N-6 and N-3) fatty acid composition in the red cells has been found to be more remarkable in SCA than other sickle cell disorders.…”

Cardiac iron and cardiac disease in males and females with transfusion-dependent thalassemia major: a T2* magnetic resonance imaging study

“…Similarly, the opposing effects of testosterone and estrogens in regulating blood levels of LDL and HDL cholesterol are not a good explanation for the mortality difference in our patients who, overall, tend to have very low levels of total cholesterol. 20 However, the gender difference in survival was already present in a survey performed in 1983, including patients born before 1970, when only a small proportion of patients had spontaneous puberty and very few were receiving hormone replacement therapy. In addition, it has been suggested that women survive longer because they have a slower metabolic rate almost from the moment of conception, when male embryos divide faster than female ones.…”

Hypocholesterolaemia in Thalassaemia – Pathogenesis, Implications and Clinical Effects

“…8 Finally, in a study evaluating hypocholesterolaemia among thalassaemia intermedia patients, a significant inverse correlation was found between cholesterol level and soluble transferrin receptor. 27 Further studies are needed to better elucidate the relationship between…”