Prevalence of Anemia in Patients with COPD and Its Potential Impact on Morbidity of COPD Patients

Abstract

Background: Although COPD is traditionally associated with polycythemia, the systemic inflammation that is now recognized as a feature of COPD makes it a possible cause of Anemia of Chronic Disease (ACD). Preliminary evidences suggest that anemia in COPD may be more prevalent than expected occurring in 10% -15% of patients. While in states like chronic heart failure and renal insufficiency, anemia has been extensively studied; little attention has been given to it in COPD. Objectives: To see the prevalence of anemia in patients with COPD and its potential impact on morbidity of COPD patients. Design and Setting: A university hospital-based cross-sectional study in Kashmir, India. Methods: Two hundred patients (119 males and 81 females) with spirometery documented COPD were evaluated for frequency of anemia. In addition to routine investigations, erythropoietin levels were done in a subgroup of patients. Results: A total of 36 cases (20 males and 16 females) of anemia were detected giving a frequency of 18%. Normocytic normochromic type of anemia was present in 32 (88.89%) patients while the rest had normocytic hypochromic type of anemia. Majority of patients were in GOLD stage 11 and had decreased serum iron, transferrin saturation and TIBC. Erythropoietin levels were significantly raised in anemic COPD patients compared to non-anemic COPD patients. The various factors significantly associated with anemia were: No. of exacerbations of COPD, No. of hospital admissions, BMI and erythropoietin levels. Conclusion: Anemia occurs frequently in patients of COPD and is associated with increased morbidity in the form of No. of exacerbations and hospital admissions. Correcting anemia in these patients may improve their clinical outcome.

Study of Chronic Kidney Disease and Anemia in Chronic Obstructive Pulmonary Disease (Copd) Patients

“…Also Khandelwal et al (6) found that anemia was present in almost 42.3% of all COPD patients. In disagreement of our result, Parveen et al (36) found that the frequency of anemia in COPD patients was 18% and 12.3% in Ferrari et al (7) study which are less than our result. The difference between our result and the above results and the wide range of the frequency of anemia in COPD may be due to different items, such as some studies which are retrospective, use of different populations (COPD in exacerbated or stability phase; outpatients or inhospital patients, the use of several cut-off levels of Hb to define anemia and the presence of confusing factors such as the presence of many other reasons of anemia like renal failure, neoplasm, heart failure, etc.…”

“…In concordance with our result of the significant negative correlation between COPD severity and Hb level affection (Table 5), Chambellan et al (33) observed that there was a relationship between anemia and other factors like BMI, age, blood gas analysis and COPD severity. Also, Yohannes and Ershler (36) found that the frequency of associated anemia in COPD patients is highly different and depends on disease severity. Esquinas and Confalonieri (40) observed that the prevalence of anemia varied according to COPD severity.…”

Anaemia secondary to erythropoietin resistance: important predictor of adverse outcomes in chronic obstructive pulmonary disease

“…The prevalence of anaemia in previous studies is comparable to the finding of 14% in our study (Boutou et al :9 14%; John et al :10 13%; Cote et al :11 17%). An isolated Indian study by Parveen et al 3 also gives the prevalence at around 18%. The prevalence of anaemia was found to be higher in advanced stages of COPD in most of these studies 9 11.…”

“…However, the literature from developing countries regarding the same is sparse. To the best of our knowledge, there are only two such prevalence studies from India 3 17. Parveen et al 3 demonstrated a prevalence of 18% of patients with anaemia among their study population, with significant association of anaemia with number of COPD exacerbations and hospital admissions.…”

“…Preliminary evidence suggests a prevalence of anaemia in 10–15% of patients with COPD 3. A systematic review of the literature (1966–2010) estimates this prevalence to range from 7.5% to 34%, depending on the population selected and the diagnostic tools used 4.…”