Anemia in CHF

Q: Which of the following contributes to anemia in congestive heart failure (CHF) patients?  - select one

A) Dilutional anemia 

B) Iron deficiency anemia

C) Use of angiotensin converting enzyme(ACE) inhibitors 

D) Anemia of chronic disease

E) All of the above

Answer: E

This question aims to address the multifactorial causes of anemia in CHF patients. It is important to pay attention to less known causes of anemia in these patients, such as dilutional anemia or direct anemic effect of ACE inhibitors. Level of anemia correlates directly with poor prognosis. Although some factors can be modified or treated, such as dilutional or Fe-deficiency anemia, some are essential and can't be modified, such as use of ACE inhibitors.

#cardiology

#hematology

References:

1. Androne AS, Katz SD, Lund L, et al. Hemodilution is common in patients with advanced heart failure. Circulation 2003; 107:226.

2. Ishani A, Weinhandl E, Zhao Z, et al. Angiotensin-converting enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 2005; 45:391.

3. Tanner H, Moschovitis G, Kuster GM, Hullin R, Pfiiffner D, Hess OM, Mohacsi P. The prevalence of anemia in chronic heart failure. Int J Cardiol. 2002 Nov;86(1):115-21. doi: 10.1016/s0167-5273(02)00273-5. PMID: 12400591.

4. Crosato M, Steinborn W, Anker SD. Anemia in chronic congestive heart failure: frequency, prognosis, and treatment. Heart Fail Monit. 2003;4(1):2-6. PMID: 12808478.