Anemia and Inflammation in COPD*

John, Matthias MD, PhD
Hoernig, Soeren MD
Doehner, Wolfram MD
Okonko, Darlington D. MD
Witt, Christian MD, PhD
Anker, Stefan D. MD, PhD

*From the Department of Pneumology (Campus Mitte) [Drs. John, Witt, and Hoernig] and Applied Cachexia Research, Cardiology (Campus Virchow-Klinikum) [Dr. Doehner], University Hospital Charité, Berlin, Germany; and Department of Clinical Cardiology (Drs. Okonko and Anker), National Heart & Lung Institute, Imperial College, London, UK.

Manuscript received March 18, 2004; revision accepted September 23, 2004.

Reproduction of this article is prohibited without written permission from the american College of Chest Physicians (e-mail: [email protected]).

Correspondence to: Matthias John, MD, PhD, Department of Pneumology, University Hospital Charité, Campus Mitte, Schumannstr. 20/21, 10098 Berlin, Germany; e-mail: [email protected]

Chest 127(3):p 825-829, March 2005.

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.

Abbreviations: CRP = C-reactive protein; IL = interleukin; IQR = interquartile range