Anemia is common in patients with chronic diseases. However, little is known regarding the prevalence of comorbid anemia and its impact on quality of life, healthcare utilization, and mortality in patients with COPD. We conducted a systematic review and synthesis of the literature (1966 to March 2010). The prevalence of comorbid anemia in patients with COPD ranges from 7.5% to 34%, depending upon the populations selected and diagnostic tools employed to determine the level of hemoglobin. Comorbid anemia in patients with COPD was associated with greater healthcare resource utilization, impaired quality of life, older age, and male gender. Moreover, anemia in patients with COPD is an independent prognostic predictor of premature mortality and a greater likelihood of hospitalization. The true prevalence of anemia in patients with COPD is unknown. There is a lack of consensus agreement regarding this hematological abnormality's true frequency. Based on the findings from the existing literature, more work is necessary to establish the true prevalence of anemia in COPD. Robust and prospective clinical studies are needed to improve the management of COPD patients with comorbid anemia.
PauwelsRA, BuistAS, CalverleyPM, JenkinsCR, HurdSS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med, 2001; 163(5):1256–1276.
2.
ManninoDM, BuistAS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet, 2007; 370(9589):765–773.
3.
ViegiG, PistelliF, SherrillDL, MaioS, BaldacciS, CarrozziL. Definition, epidemiology and natural history of COPD. Eur Respir J, 2007; 30(5):993–1013.
4.
MurrayCJ, LopezAD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet, 1997; 349(9064):1498–1504.
5.
NiederlanderE. Cause of death in the EU. Statistics in focus - population and social conditions. Eurostat (European Communities), 2005; 101:1–12.
6.
CelliBR, CoteCG, LareauSC, MeekPM. Predictors of Survival in COPD: more than just the FEV1. Respir Med, 2008; 102(Suppl 1):S27–S35.
7.
BarrRG, CelliBR, ManninoDM, et al. Comorbidities, patient knowledge, and disease management in a national sample of patients with COPD. Am J Med, 2009; 122(4):348–355.
8.
U.S. Department of Health and Human Services. National Institutes of Health National Heart Lung and Blood Institute. Morbidity and Mortality: 2009 Chart book on Cardiovascular, Lung and Blood Diseases.
9.
ChambellanA, ChailleuxE, SimilowskiT; ANTADIR Observatory Group. Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy. Chest, 2005; 128(3):1201–1208.
10.
BarnesPJ, CelliBR. Systemic manifestations and comorbidities of COPD. Eur Respir J, 2009; 33(5):1165–1185.
11.
RennardSI. Inflammation in COPD: a link to systemic comorbidities. Eur Respir Rev, 2007; 16(105):91–97.
12.
YohannesAM, BaldwinRC, ConnollyMJ. Depression and anxiety in elderly patients with chronic obstructive pulmonary disease. Age Ageing, 2006; 35(5):457–459.
13.
SimilowskiT, AgustiA, MacNeeW, SchonhoferB. The potential impact of Anemia of chronic disease in COPD. Eur Respir J, 2006; 27(2):390–396.
14.
Nutritional anemias. Report of a WHO Scientific Group. WHO Tech Rep Sr, 1968; 405(1):5–37.
15.
IzaksGJ, WestednoropRGJ, KnookDL. The definition of Anemia in older persons. JAMA, 1999; 281(18):1714–1717.
16.
KrishnanG, GrantBJ, MutiPC, et al. Association between anemia and quality of life in a population sample of individuals with chronic obstructive pulmonary disease. BMC Pulm Med, 2006; 6:23.
17.
HalpernMT, ZilberbergMD, SchmierJK, LauEC, ShorrAF. Anemia, costs and mortality in chronic obstructive pulmonary disease. Cost Eff Resour Alloc, 2006; 4:17.
18.
JohnM, LangeA, HoernigS, WittC, AnkerSD. Prevalence of anemia in chronic obstructive pulmonary disease: comparison to other chronic diseases. Int J Cardiol, 2006; 111(3):365–370.
19.
CoteC, ZilberbergMD, ModySH, DordellyLJ, CelliB. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J, 2007; 29(5):923–929.
20.
JohnM, HoernigS, DoehnerW, OkonkoDD, WittC, AnkerSD. Anemia and inflammation in COPD. Chest, 2005; 127(3):825–829.
21.
ShorrAF, DoyleJ, SternL, DolgitserM, ZilberbergMD. Anemia in chronic obstructive pulmonary disease: epidemiology and economic implications. Curr Med Res Opin, 2008; 24(4):1123–1130.
22.
WeissG, GoodnoughLT. Anemia of chronic disease. N Engl J Med, 2005; 352(10):1011–1023.
23.
TassiopoulosS, KontosA, KonstantopoulosK, et al. Erythropoietic response to hypoxaemia in diffuse idiopathic pulmonary fibrosis, as opposed to chronic obstructive pulmonary disease. Respir Med, 2001; 95(6):471–475.
24.
MeansRTJr, KrantzSB. Progress in understanding the pathogenesis of the anemia of chronic disease. Blood, 1992; 80(7):1639–1647.
25.
CartwrightGE. The anemia of chronic disorders. Semin Hematol, 1966; 3(4):351–375.
26.
CashJM, SearsDA. The anemia of chronic disease: spectrum of associated diseases in a series of unselected hospitalized patients. Am J Med, 1989; 87(6):638–644.
27.
OpasichC, CazzolaM, ScelsiL, De FeoS, BosiminiE, LagioliaR, et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anemia in patients with chronic heart failure. Eur Heart J, 2005; 26(21):2232–2237.
28.
MoldawerLL, GelinJ, ScherstenT, LundholmKG. Circulating interleukin 1 and tumor necrosis factor during inflammation. Am J Physiol, 1987, 253(6 Pt 2):R922–R928.
29.
MeansRTJr., KrantzSB. Inhibition of human erythroid colony-forming units by interferons alpha and beta: differing mechanisms despite shared receptor. Exp Hematol, 1996; 24(2):204–208.
30.
MeansRTJr., DessyprisEN, KrantzSB. Inhibition of human erythroid colony-forming units by interleukin-1 is mediated by gamma interferon. J Cell Physiol, 1992; 150(1):59–64.
31.
MaccioA, MadedduC, MassaD, et al. Hemoglobin levels correlate with interleukin-6 levels in patients with advanced untreated epithelial ovarian cancer: role of inflammation in cancer-related anemia. Blood, 2005; 106(1):362–367.
32.
NemethE, RiveraS, GabayanV, et al. IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J Clin Invest, 2004; 113(9):1271–1276.
33.
NemethE, TuttleMS, PowelsonJ, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science, 2004; 306(5704):2090–2093.
34.
RajDS. Role of interleukin-6 in the anemia of chronic disease. Semin Arthritis Rheum, 2009; 38(5):382–388.
35.
GanzT. Hepcidin in iron metabolism. Curr Opin Hematol, 2004; 11(4):251–254.
36.
GanzT, NemethE. Iron imports. IV. Hepcidin and regulation of body iron metabolism. Am J Physiol Gastrointest Liver Physiol, 2006; 290(2):G199–G203.
37.
RiveraS, NemethE, GabayanV, LopezMA, FarshidiD, GanzT. Synthetic hepcidin causes rapid dose-dependent hypoferremia and is concentrated in ferroportin-containing organs. Blood, 2005; 106(6):2196–2199.
38.
RoyCN, AndrewsNC. Anemia of inflammation: the hepcidin link. Curr Opin Hematol, 2005; 12(2):107–111.
39.
AndrewsNC. Anemia of inflammation: the cytokine-hepcidin link. J Clin Invest, 2004; 113(9):1251–1253.
40.
DallalioG, LawE, MeansRTJr. Hepcidin inhibits in vitro erythroid colony formation at reduced erythropoietin concentrations. Blood, 2006; 107(7):2702–2704.
41.
GuralnikJM, EisenstaedtRS, FerrucciL, KleinHG, WoodmanRC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood, 2004; 104(8):2263–2268.
42.
CarrozKP. [Anemia in COPD: should it be taken into consideration?]. Arch Bronconeumol, 2007; 43(7):392–398. Article in Spanish.
43.
FabbriLM, RabeKF. From COPD to chronic systemic inflammatory syndrome?. Lancet, 2007; 370(9589):797–799.
44.
SchonhoferB, WenzelM, GeibelM, KohlerD. Blood transfusion and lung function in chronically anaemic patients with severe chronic obstructive pulmonary disease. Crit Care Med, 1998; 26(11):1824–1828.
45.
CappellMS, NadlerSC. Increased mortality of acute upper gastrointestinal bleeding in patients with chronic obstructive pulmonary disease. A case controlled, multiyear study of 53 consecutive patients. Dig Dis Sci, 1995; 40(2):256–262.
46.
UpchurchGRJr., ProctorMC, HenkePK, et al. Predictors of severe morbidity and death after elective abdominal aortic aneurysmectomy in patients with chronic obstructive pulmonary disease. J Vasc Surg, 2003; 37(3):594–599.
47.
CelliBR, CoteCG, MarinJM, CasanovaC, Montes de OcaM, MendezRA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med, 2004; 350(10):1005–1012.
48.
MahlerDA, JonesPW. Measurement of dyspnea and quality of life in advanced lung disease. Clin Chest Med, 1997; 18(3):457–469.
49.
TheanderK, UnossonM. Fatigue in patients with chronic obstructive pulmonary disease. J Adv Nurs, 2004; 45(2):172–177.
50.
SobreroA, PuglisiF, GuglielmiA, BelvedereO, AprileG, RamelloM, GrossiF. Fatigue: a main component of anemia symptomatology. Semin Oncol, 2001; 28(2 Suppl 8):15–18.
51.
JonesPW, QuirkFH, BaveystockCM. The St George's Respiratory Questionnaire. Respir Med, 1991; 85(Suppl B):25–31; discussion 33-37..
52.
SchünemannHJ, GoldsteinR, MadorMJ, McKimD, StahlE, PuhanM, et al. A randomised trial to evaluate the self-administered standardised chronic respiratory questionnaire. Eur Respir J, 2005; 25(1):31–40.
