Background: Chronic Obstructive Pulmonary Disease (COPD) is defined as a common, preventable and treatable disease. COPD is known to be associated with secondary polycythemia but anemia is also common and less studied in these patients. So we conducted a study to see the prevalence anemia in COPD patients.

Methods: A Cross sectional observational study performed in the Department of  Pulmonary Medicine, Department of Biochemistry, Nizam’s Institute Of  Medical Sciences (NIMS), Hyderabad, Telangana. The study group consisted of 120 patients who presented to the outpatient department of NIMS hospital during study period. Hemogram, Renal function test, Liver function test, BMI calculation, Dyspnea scoring according to modified Medical Research Council (mMRC), 6minute walk test were done in confirmed cases of COPD.

Results: Total 120 patients included in the study. Mean age of the study group was 60.13 ± 7.9, with age ranging from 43 - 80 years. Of the total population, anemia was present in 24 (20%) patients and polycythemia was present in 8 (6.67%) patients. Mean haemoglobin values for anemic, Polycythemia and normal patients were 13.48 ± 2.47 gm/dl, 18.13 ± 0.64 gm /dl and 14.16 ± 0.93 gm/dl respectively. In anemic patients, most of them, i.e. 22 (91.67%) had normocytic normochromic (NCNC) anemia and 2 (8.33%) patients had microcytic hypochromic (MCHY) anemia.

Conclusion: Anemia occurs more frequently than polycythemia in patients with COPD. The most common type of anemia associated with COPD is normocytic normochromic anemia. Most of the anemic patients were in GOLD Grade III severity. Anemic COPD patients have a significantly lower BMI, FEV1 % predicted values, dyspnea by mMRC dyspnea scale and exercise capacity by 6MWD, compared to nonanemic COPD patients.

Keywords: Anemia, COPD.

1. World Health Report. Geneva: World Health Organization. Available from URL:http//www.who.int/whr/2000/en/statistics.htm;2000.
2. Murray CJL, Lopez AD. Alternative projection of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349:1498-504.
3. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006; 28:523–532.
4. Kurmi OP, Lam KB, Ayres JG. Indoor air pollution and the lung in low- and medium-income countries. Eur Respir J. 2012; 40:239.
5. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet.2009; 374:733.
6. Murthy KJR, Sastry JG. Economic burden of chronic obstructive pulmonary disease. National Commission on Macroeconomics and Health (NCMH) background papers. 2005. pp. 265–74.
7. Decramer M, Rennard S, Troosters T, Mapel DW, Giardino N, Mannino D, et al. COPD as a lung disease with systemic consequences Clinical impact, mechanisms, and potential for early intervention. COPD 2008; 5:235 56.
8. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J RespirCrit Care Med 2013; 187:347 65.
9. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009; 33:1165 85.
10. Zielinski J. Effects of long-term oxygen therapy in patients with chronic obstructive pulmonary disease. Curr Opin Pulm Med 1999; 5: 81–87.
11. John M, Hoernig S, Doehner W, Okonko DD, Witt C, Anker SD. Anemia and inflammation in COPD. Chest 2005; 127: 825–829.
12. World Health Organization. Nutritional anemia’s: report of a WHO scientific group. WHO Technical Report Series 405. Geneva, World Health Organization, 1968; pp. 1–37.
13. Cote, M.D. Zilberberg, S.H. Mody et al. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J 2007; 29: 923–929.
14. Marathias KP, Agroyannis B, Mavromoustakos T, Matsoukas J, Vlahakos DV. Hematocrit‑lowering effect following inactivation of renin‑angiotensin system with angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Curr Top Med Chem 2004; 4:483‑6.
15. Gokul Krishnan, Brydon J Grant, Paola C Muti et al. Association between anemia and quality of life in a population sample of individuals with chronic obstructive pulmonary disease. BMC Pulmonary Medicine 2006, 6:23.
16. Chambellan A, Chailleux E, Similowski T, ANTADIR Observatory Group. Prognostic value of hematocrit in patients with severe COPD receiving long-term oxygen
    Chest 2005; 128: 1201–1208.
17. Halpern MT, Zilberberg MD, Schmier JK, Lau EC, Shorr AF. Anemia, costs and mortality in chronic obstructive pulmonary disease. Cost EffResourAlloc 2006; 4:17.
18. Shorr AF, Doyle J, Stern L, Dolgitser M, Zilberberg MD. Anemia in chronic obstructive pulmonary disease: Epidemiology and economic implications. Curr Med Res Opin 2008; 24:1123‑30.
19. Cote, M.D. Zilberberg, S.H. Mody et al. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J 2007; 29: 923–929.
20. Attaran D, Khajedalouee M, Ahmadi F, Rezaeitalab F, Towhidi M, Asnaashari A, et al. Anemia in COPD patients and its relation to serum levels of erythropoietin. Tanaffos. 2009; 8:11–6.
21. Boutou AK, Stanopoulos I, Pitsiou GG, Kontakiotis T, Kyriazis G, Sichletidis L, et al. Anemia of chronic disease in chronic obstructive pulmonary disease: A case‑control study of cardiopulmonary exercise responses. Respiration 2011; 82:237‑45.
22. Silverberg DS, Mor R, Weu MT, Schwartz D, Schwartz IF, Chernin G. Anemia and iron deficiency in COPD patients: Prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron. BMC Pulm Med 2014; 14:24.
23. Parveen S, Rangreze I, Ahmad SN, Mufti SA, Khan SS. Prevalence of anemia in patients with COPD and its potential impact on morbidity of COPD patients. Int J Clin Med 2014; 5:452‑8.

Rajendraprasad.B

Consultant Pulmonologist, Vision Hospital Nizamabad, Telangana 503001, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.