Share This Article:

Iron-Restricted Erythropoiesis in Anaemic Patients with Giant Cell Arteritis and Polymyalgia Rheumatica

Abstract Full-Text HTML XML Download Download as PDF (Size:128KB) PP. 49-52
DOI: 10.4236/ojbd.2013.31010    3,166 Downloads   5,403 Views  

ABSTRACT

The aim of this observational study was to biochemically characterize the anaemia in GCA (giant cell arteritis) and PMR (polymyalgia rheumatica) patients. Values for mean corpuscular volume, mean corpuscular hemoglobin and soluble transferrin receptor were normal, whereas serum iron and total iron binding capacity (TIBC) were subnormal, and mean ferritin was above the upper reference limit. Iron-restricted erythropoiesis (IRE), defined as a bone marrow smear staining positive for iron in combination with transferrin saturation less than 20%, was present in all patients. All patients exhibited clinical and biochemical signs of active inflammation with elevated C-reactive protein and an increased erythrocyte sedimentation rate.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

T. Karlsson, "Iron-Restricted Erythropoiesis in Anaemic Patients with Giant Cell Arteritis and Polymyalgia Rheumatica," Open Journal of Blood Diseases, Vol. 3 No. 1, 2013, pp. 49-52. doi: 10.4236/ojbd.2013.31010.

References

[1] L. Goodnough, E. Nemeth and T. Ganz, “Detection, Evaluation, and Management of Iron-Restricted Erythropoiesis,” Blood, Vol. 116, No. 23, 2010, pp. 4754-4761. doi:10.1182/blood-2010-05-286260
[2] E. Nemeth, S. Rivera, V. Gabayan, C. Keller, S. Taudorf, K. Pedersen and T. Ganz, “IL-6 Mediates Hypoferremia of Inflammation by Inducing the Synthesis of the Iron Regulatory Hormone Hepcidin,” Journal of Clinical Investigation, Vol. 113, No. 9, 2004, pp. 1271-1276.
[3] E. Nemeth, M. Tuttle, J. Powelson, M. Vaughn, A. Donovan, D. McVey Ward, T. Ganz and J. Kaplan, “Hepcidin Regulates Cellular Iron Efflux by Binding to Ferroportin and Inducing Its Internalization,” Science, Vol. 306, No. 5704, 2004, pp. 2090-2093. doi:10.1126/science.1104742
[4] S. Rivera, L. Liu, E. Nemeth, V. Gabayan, O. Sorenson and T. Ganz, “Hepcidin Excess Induces the Sequestration of Iron and Exacerbates Tumor-Associated Anemia,” Blood, Vol. 105, No. 4, 2005, pp. 1797-1802. doi:10.1182/blood-2004-08-3375
[5] L. Viatte, G. Nicolas, D.-Q. Lou, M. Bennoun, J.-C. Lebordes-Brion, F. Cannone-Hergaux, K. Sch?nig, H. Bujard, A. Kahn, N. Andrews and S. Vaulont, “Chronic Hepcidin Induction Causes Hypoferremia and Alters the Pattern of Cellular Iron Accumulation in Hemochromatotic Mice,” Blood, Vol. 107, No. 7, 2006, pp. 2952-2958. doi:10.1182/blood-2005-10-4071
[6] F. Locatelli, A. Covic, K.-U. Eckardt, A. Wiecek, R. Wanholder and on Behalf of the ERA-EDTA Advisory Board, “Anemia Management in Patients with Chronic Kidney Disease: A Position Statement by the Anemia Working Group of European Renal Best Practice,” Nephrology Dialysis Transplantation, Vol. 24, No. 2, 2009, pp. 348-354. doi:10.1093/ndt/gfn653
[7] T. Karlsson, “Effects of Iron Supplementation on Erythropoietic Response in Patients with Cancer-Associated Anemia Treated by Means of Erythropoietic Stimulating Agents,” ISRN Hematology, Vol. 2011, No. 2011, 2011, Article ID: 108397. doi:10.1155/1759
[8] H. Bird, “Review of Diagnostic Criteria for Polymyalgia Rheumatica/Giant Cell Arteritis,” Rheumatology, Vol. 44, No. S3, 2005, pp. iii2-iii3. doi:10.1093/rheumatology/keh731
[9] J. Jones and B. Hazleman, “Polymyalgia Rheumatica—A Difficult Diagnosis,” The Journal of the Royal College of General Practitioners, Vol. 32, No. 226, 1981, pp. 286-289.
[10] K. Wilske and L. Healey, “Polymyalgia Rheumatica,” Annals of Internal Medicine, Vol. 66, No. 5, 1967, pp. 1069-1069.
[11] L. Healey and K. Wilske, “Anemia as a Presenting Manifestation of Giant Cell Arteritis,” Arthritis & Rheumatism, Vol. 14, No. 1, 1971, pp. 27-31. doi:10.1002/art.1780140105
[12] G. Hunder, D. Bloch, B. Michel, M. Stevens, W. Arend, L. Calabrese, S. Edworthy, A. Fauci, R. Leavitt, J. Lie, R. Lightfoot, A. Masi, D. McShane, J. Mills, S. Wallace and N. Zvaifer, “The American College of Rheumatology 1990 Criteria for the Classification of Giant Cell Arteritis,” Arthritis and Rheumatism, Vol. 33, No. 8, 1990, pp. 1122-1128. doi:10.1002/art.1780330810
[13] R. Stasi, S. Amadori, T. Littlewood, E. Terzoli, A. Newland and D. Provan, “Management of Cancer-Related Anemia with Erythropoietic Agents: Doubts, Certainties, and Concerns,” Oncologist, Vol. 10, No. 7, 2005, pp 539-554. doi:10.1634/theoncologist.10-7-539
[14] M. Woorwood, “Laboratory Determination of Iron Status,” In: J. Brock, J. Halliday, M. Pippard and L. Powell, Eds., Iron Metabolism in Health and Disease, W. B. Saunders, London, 1994, pp. 449-476.
[15] A. Baer, E. Dessypris and B. Krantz, “The Pathogenesis of Anemia in Rheumatoid Arthritis: A Clinical and Laboratory Analysis,” Seminars in Arthritis and Rheumatism, Vol. 19, No. 4, 1990, pp. 209-223. doi:10.1016/0049-0172(90)90001-V
[16] T. Karlsson, “Iron-Restricted Erythropoiesis in a Population of Elderly Hospitalized Anemic Patients,” Open Journal of Blood Disease, Vol. 2, No. 2, 2012, pp. 30-33. doi:10.4236/ojbd.2012.22006
[17] A. Erslev, “Anemia of Chronic Disease,” In: E. Beutler, M. Lichtmann, B. Coller, T. Kipps and U. Seligsohn, Eds., Williams Hematology, 6th Edition, McGraw-Hill, New York, 2001, pp. 481-487.
[18] G. Vreugdenhil, A. Wognum, H. van Eik and A. Swaak, “Anaemia in Rheumatoid Arthritis: The Role of Iron, Vitamin B12, and Folic Acid Deficiency, and Erythropoietin Deficiency,” Annals of the Rheumatic Diseases, Vol. 49, No. 2, 1990, pp. 93-98. doi:10.1136/ard.49.2.93
[19] H. Peeters, M. Jongen-Lavrencic, A. Raja, H. Ramdin, G. Vreugdenhil, F. Breedveld and A. Swaak, “Course and Characteristics of Anaemia in Patients with Rheumatoid Arthritis of Recent Onset,” Annals of the Rheumatic Diseases, Vol. 55, No. 3, 1996, pp. 162-168. doi:10.1136/ard.55.3.162
[20] C. Thomas and L. Thomas, “Anemia of Chronic Disease: Pathophysiology and Laboratory Diagnosis,” Laboratory Hematology, Vol. 11, No. 1, 2005, pp. 14-23. doi:10.1532/LH96.04049
[21] M. Jeffrey, “Intravenous Iron in Rheumatoid Arthritis: Possible Prognostic Factors,” British Medical Journal, Vol. 2, 1953, pp. 912-913. doi:10.1136/bmj.2.4842.912
[22] H. Peeters, M. Jongen-Lavrencic, G. Vreugdenhill and A. Swaak, “Effect of Recombinant Human Erythropoietin on Anaemia and Disease Activity in Patients with Rheumatoid Arthritis and Anaemia of Chronic Disease: A Randomized Placebo Controlled Double Blind 52 Weeks Clinical Trial,” Annals of the Rheumatic Diseases, Vol. 55, No. 10, 1996, pp. 739-744. doi:10.1136/ard.55.10.739
[23] H. Peeters, M. Jongen-Lavrencic, C. Bakker, G. Vreugdenhill, F. Breedveld and A. Swaak, “Recombinant Human Erythropoietin Improves Health-Related Quality of Life in Patients with Rheumatoid Arthritis and Anaemia of Chronic Disease: Utility Measures Correlate Strongly with Disease Activity Measures,” Rheumatology International, Vol. 18, No. 5-6, 1999, pp. 201-206. doi:10.1007/s002960050085
[24] J. Kaltwasser, U. Kessler, R. Gottschalk, G. Stucki and B. M?ller, “Effect of Recombinant Human Erythropoietin and Intavenous Iron on Anemia and Disease Activity in Rheumatoid Arthritis,” Journal of Rheumatology, Vol. 28, No. 11, 2001, pp. 2430-2436.
[25] J. Richmond, L. Roy, D. Gardner, W. Alexander and J. Duthie, “Nature of Anaemia in Rheumatoid Arthritis IV. Effects of the Intravenous Administration of Saccharated Oxide of Iron,” Annals of the Rheumatic Diseases, Vol. 17, No. 4, 1958, pp. 406-415. doi:10.1136/ard.17.4.406
[26] D. Bentley and P. Williams, “Pareneteral Iron Therapy in the Anemia of Rheumatoid Arthritis,” Rheumatology, Vol. 21, No. 2, 1982, pp. 88-92. doi:10.1093/rheumatology/21.2.88
[27] P. Reddy and M. Lewis, “The Adverse Effect of Intravenous Iron-Dextran in Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 12, No. 4, 1969, pp. 454-457. doi:10.1002/art.1780120413
[28] D. Blake, J. Lunec, M. Ahern, E. Ring, J. Bradfield and J. Gutteridge, “Effect of Intravenous Iron Dextran on Rheumatoid Synovitis,” Annals of the Rheumatic Diseases, Vol. 44, No. 3, 1985, pp. 183-188. doi:10.1136/ard.44.3.183
[29] S. Fishbane, G. Frei and J. Maesaka, “Reduction in Recombinant Human Erythropoietin Doses by the Use of Chronic Intravenous Iron Supplementation,” American Journal of Kidney Diseases, Vol. 26, No. 1, 1995, pp. 41-46. doi:10.1016/0272-6386(95)90151-5
[30] D. Silverberg, A. Iaina, G. Peer, E. Kaplan, B. A. Levi, N. Frank, S. Steinbruch and M. Blum, “Intravenous Iron Supplementation for the Treatment of the Anemia of Moderate to Severe Chronic Renal Failure Patients Not Receiving Dialysis,” American Journal of Kidney Diseases, Vol. 27, No. 2, 1996, pp. 234-238. doi:10.1016/S0272-6386(96)90546-6
[31] G. Mirescu, L. Garneata, C. Capusa and N. Ursea, “Intravenous Iron Supplementation for the Treatment of Anaemia in Pre-Dialyzed Chronic Renal Failure Patients,” Nephrology Dialysis Transplantation, Vol. 21, No. 1, 2006, pp. 120-124. doi:10.1093/ndt/gfi087
[32] S. Anker, J. CominColet, G. Filippatos, R. Willenheimer, K. Dickstein, H. Drexler, T. Luscher, B. Bart, W. Banasiak, J. Niegowska, B.-A. Kirwan, C. Mori, B. von EisenhartRothe, M. S. Pocock, P. Poole-Wilson and P. Ponikowski, “Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency,” New England Journal of Medicine, Vol. 361, No. 25, 2009, pp. 2436-2448. doi:10.1056/NEJMoa0908355
[33] D. Henry, N. Dahl, M. Auerbach, S. Tchekmedyian and L. Laufmane, “Intravenous Ferric Gluconate Significantly Improves Response to Epoetinalfa versus Oral or No Iron in Anemic Patients with Cancer Receiving Chemotherapy,” Oncologist, Vol. 12, No. 2, 2007, pp. 231-242. doi:10.1634/theoncologist.12-2-231
[34] M. Hedenus, G. Birgeg?rd, P. N?sman, L. Ahlberg, T. Karlsson, B. Lauri, J. Lundin, G. L?rfars and A. ?sterborg, “Addition of Intravenous Iron to Epoetin Beta Increases Hemoglobin Response and Decreases Epoetin Dose Requirement in Anemic Patients with Lymphoproliferative Malignancies: A Randomized Multicenter Study,” Leukemia, Vol. 21, No. 4, 2007, pp. 627-632.
[35] E. Katodritou, E. Terpos, K. Zervas, M. Speletas, D. Kapetanos, C. Kartsios, E. Verrou, A. Banti, S. Effraimidou and J. Christakis, “Hypochromic Erythrocytes (%): A Reliable Marker for Recognizing Iron-Restricted Erythropoiesis and Predicting Response to Erythropoietin in Anemic Patients with Myeloma and Lymphoma,” Annals of Hematology, Vol. 86, No. 5, 2007, pp. 369-376. doi:10.1007/s00277-007-0258-x

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.