Characteristics and clinical relevance of chronic anemia in adult heart transplant recipients

Background: Mild chronic anemia following heart transplantation (HTX), with hemoglobin (Hb) values of 10-14 g/dL in men and 10-12 g/dL in women, is fr equent. It has continued to be of uncertain etiology yet clinical relevance . Nonetheless, therapeutic immunosuppression has been regarded as a major c ause of chronic anemia in HTX patients. Methods: Sixty outpatients were observed over a period of 5 yr after HTX. L aboratory values related to anemia such as Hb, erythropoietin (EPO), ferrit in, transferrin, iron, and vitamin levels were obtained and analyzed monthl y. Patients were divided into two groups retrospectively. Patients with per sistent anemia for more than 1 yr were compared with non-anemic patients. Results: Forty-three (72%) of the 60 patients were anemic. Anemia was normo chromic, normocytic, and slightly anisocytic. Anemic and nonanemic patients showed EPO levels within the expected range as defined by Erslev (Erythrop oietin. N Engl J Med 1991: 324: 1339). Reticulocyte counts were found to be normal in all patients. Iron deficiency and deficiency of vitamin B-12 or folic acid were not observed. Patients with persistent anemia showed a sign ificantly shorter survival period than non-anemic patients (p < 0.02). Conclusions: Mild anemia following HTX shows the same characteristics as an emia in chronic diseases. Persisting mild anemia used to be associated with a shorter life expectancy. There is no evidence that standard immunosuppre ssion causes anemia.