Hemodilution Is Common in Patients With Advanced Heart Failure

Abstract

Background— Anemia frequently occurs in chronic heart failure (CHF) patients and is associated with a poor prognosis. A low hematocrit may result from an increased plasma volume (hemodilution) or from reduced red blood cell volume (true anemia). The prevalence and clinical outcome of CHF patients with hemodilution is unknown. Methods and Results— The prevalence of anemia and its effect on outcome was examined in 196 patients with CHF. The prevalence of hemodilution was assessed in a subset of 37 ambulatory anemic patients with I 131 -tagged albumin to measure red blood cell and plasma volume. Clinical outcome was monitored. Sixty-one percent of the CHF patients were anemic. The prevalence of anemia increased from 33% in patients with New York Heart Association class II heart failure to 68% in class IV CHF patients. Survival was reduced in anemic patients compared with patients with a normal hematocrit ( P <0.05). In the subset of 37 anemic patients, 17 patients (46%) had hemodilution and 20 patients (54%) had a true anemia. Nine patients with hemodilution died or underwent urgent transplant compared with 4 patients in the true anemia group ( P <0.04). Conclusion— Hemodilution is common in CHF patients. Anemia is associated with a poor prognosis in CHF. Patients with hemodilution tend to do worse than patients with true anemia, which suggests that volume overload may be an important mechanism contributing to the poor outcome in anemic CHF patients.

Relationship of B‐type natriuretic peptide and anemia in patients with and without heart failure: A substudy from the Breathing Not Properly (BNP) Multinational Study

“…It may be possible that the low hemoglobin is the result of hemodilution of the blood by excess fluids in systolic failure. However, true anemia reflected by a decrease in red cell mass is equally common among systolic HF patients [24].…”

Prevalence of Iron Deficiency Anemia in Patients with Chronic Heart Failure

“…[11][12][13][14][15] These findings in a different array of CHF populations are remarkably concordant and commonly, suggest a linear association between decreased hemoglobin and increased mortality risk.…”

“…[2] Estimates of the prevalence of anemia in patients with CHF and low ejection fraction range widely from 4% to 61% (median 18%). [3][4][5][6] Variability in estimated prevalence is partly attributable to use of inconsistent definitions of anemia in individual reports. The World Health Organization definition of anemia (hemoglobin concentration <13.0 g/dL in men and <12.0 g/dL in women) takes into account known gender difference in the distribution of hemoglobin values, [7] whereas the National Kidney Foundation defines anemia as hemoglobin ≤12 g/dL in men and postmenopausal women.…”

The Role of Anemia in the Progression of Congestive Heart Failure: Is There a Place for Erythropoietin and Intravenous Iron?

“…EPO production and utilization can be inhibited by ACE inhibitors which can cause anemia. 109 Finally, part of the anemia in CHF may be due to hemodilution, 17 but recent studies show that the majority of anemic CHF patients actually have a reduced red cell volume. 17 The Vicious Circle of CHF, CKI, and Anemia -The Cardio Renal Anemia (CRA) Syndrome…”