THE USA JOURNALS
THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH
(ISSN
–
2689-1026)
VOLUME 06 ISSUE09
37
https://www.theamericanjournals.com/index.php/tajmspr
PUBLISHED DATE: - 25-09-2024
https://doi.org/10.37547/TAJMSPR/Volume06Issue09-06
PAGE NO.: - 37-40
ANEMIA AND FERROKINETIC PARAMETERS
IN PATIENTS WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Muminov Kadir Pulatovich
MD, Associate Professor, The Republican Specialized Scientific and Practical
Medical Center for Therapy and Medical Rehabilitation, Uzbekistan
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is
one of the leading causes of morbidity and
mortality in modern society and represents a
significant economic and social problem that does
not yet tend to improve [5,8]. It is known that the
prevalence, morbidity and mortality of COPD are
associated with the prevalence of tobacco smoking
and air pollution, and therefore varies in different
countries [3,4]. At the same time, in recent years,
much attention has been paid to the study of a
number of other exogenous and endogenous risk
factors for the occurrence and progression of
COPD. A number of studies have shown that
changes in blood rheology are common in patients
with COPD and can be considered a definite risk
factor for the progression of COPD. However, the
incidence and prognostic role of changes in the
main parameters of peripheral blood have not
been sufficiently studied [1,6]. In this regard, the
purpose of the study was to study the incidence of
anemia and ferrokinetic parameters in patients
with chronic obstructive pulmonary disease.
RESEARCH ARTICLE
Open Access
Abstract
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METHODS
80 patients with COPD were under observation,
among whom there were 51 (63.7%) men and 29
(36.3%) women. Grade 1 COPD severity was
diagnosed in 25 patients, grade II
–
in 28 and grade
III
–
in 27 patients. The diagnosis of “Chronic
obstructive pulmonary disease” was established
based on the criteria set out in the “Global strategy
for the diagnosis, treatment and prevention of
COPD” GOLD program
(2003). The control group
consisted of 20 healthy individuals of the
appropriate age. The average age of the patients
was 47±1.5 years. A general blood test was
performed according to standard methods.
Features of ferrokinetics were assessed by
hemoglobin concentration (anemia was diagnosed
when the level of Hb < 120 g/l in women and Hb <
130 g/l in men) serum iron (normal level in men
8.1-26.6 µmol/l, in women 5.4-26.0 µmol/l),
ferritin (normal level in men 30-400 ng/ml, in
women under 50 years of age 15-150 ng/ml, in
women after 50 years 30-400 ng/ml), transferrin
(optimal level 2.0-3.6 g/l).
RESULTS AND DISCUSSION
As a result of the studies, anemia was detected in
17.5% of patients with COPD, and polycythemia in
5%. At the same time, iron deficiency anemia (IDA)
was detected in 10 patients with COPD, iron
concentration was reduced in 8 patients, serum
ferritin was below 100 ng/ml in 9 patients, serum
transferrin was reduced in 10 COPD patients with
anemia.
Some blood parameters of COPD patients with and without anemia
.
Parameters
Control
group
(n = 20)
COPD
without
anemia
(n = 62)
COPD
with
anemia
(n = 14)
COPD
with
polycythemia (n
= 4)
Hemoglobin, g/l
127±5,87
143,31±2,49**
68,87±2,08
157±15,28
Hematocrit, %
38,1±1,7
42,9±1,7*
31,5±1
47,2±4,4
Red blood cells/pl
4,3±0,2
4,7±0,2
4±0,1
5,8±1
Serum iron, µmol/l
14,3±0,6
13,4±0,7
13,4±0,5
14,5±1,4
Ferritin, ng/ml
184,4±8,4
189,9±7,6
182,7±5,8
187,3±24,3
Transferrin g/l
2,7±0,1
2,2±0,1***
2,1±0,1
2,6±0,2
CRP (log), mg/dl
0,2±0***
0,5±0
0,5±0,1
Note: * P<0.05, ** P<0.01,***P<0.001–statistical significance compared to control.
Thus, every fifth COPD patient examined suffered
from anemia, although it is traditionally believed
that patients with COPD suffer from polycythemia.
This confirms the hypothesis about the
inhomogeneity of the phenotypic types of COPD
and the need for a differentiated approach in
prognosis and treatment of this cohort of patients
[2]. At the same time, analysis of iron metabolism
indicators during the study demonstrated that not
all patients with COPD in combination with anemia
suffer from iron deficiency. Therefore, a
differentiated approach is necessary when
prescribing iron supplements to these patients,
depending on the concentrations of iron, ferritin
and serum transferrin.
According to the results of our study, the level of C-
reactive protein in patients with COPD was
significantly higher than in the examined
individuals in the control group. Moreover, this
indicator was significantly higher in COPD patients
with anemia compared to COPD patients without
anemia (Table1).
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The level of erythropoietin in the blood serum of
COPD patients with anemia was 2.5 times higher
than the same indicator in COPD patients without
anemia. This may be explained by the resistance of
the bone marrow of these patients to
erythropoietin, which is a common finding in
anemia of chronic diseases. [7,9]. According to a
number of studies, according to its genesis, anemia
in patients with COPD belongs to the so-called.
anemia of chronic diseases, i.e. its cause is
obviously systemic inflammation. Serum cytokines
and chemokines can disrupt the main stages of
hematopoiesis; possible mechanisms of anemia in
COPD are shortening of erythrocyte apoptosis,
impaired mobilization and utilization of iron, and
impaired
bone
marrow
response
to
erythropoietin.
When studying ferrokinetics indicators in COPD
patients with various degrees of severity, it was
noted that as the patients’ condition worsens, the
hematological status changes with a shift towards
anemia. Among patients with mild COPD, the
average hemoglobin level was comparable to that
of the control group, while in patients with grade
III COPD there were manifestations of anemia.
Hematocrit values changed similarly.
However, in the group of patients with stage III
COPD, the ferritin indicator was increased both in
comparison with the control group and in
comparison with the groups of patients with mild
and moderate COPD. Obviously, ferritin, which is
an indicator of iron depots in the div, was
elevated in this group due to impaired transport of
iron from the iron depots existing in the div,
which indicates a functional iron deficiency in this
group of patients.
It should be noted that patients with anemia
differed from other patients with COPD in more
severe shortness of breath and decreased
tolerance to physical activity, which in itself
aggravated the course of the disease. A correlation
analysis revealed a direct correlation between the
degree of anemia and the severity of bronchial
obstruction, as well as an inverse correlation
between the concentration of C-reactive protein
and hematocrit in patients with COPD. This may
indicate the pathogenetic role of bronchial
obstruction, as well as systemic inflammation in
the development of anemia, thereby closing a
vicious circle and contributing to an unfavorable
prognosis of COPD.
CONCLUSION
Thus, the incidence of anemia in COPD increases as
the severity of the disease increases. According to
its genesis, anemia in patients with COPD belongs
to the so-called, anemia of chronic diseases and can
be considered a definite risk factor for the
progression of COPD. In this regard, a
differentiated approach is required in the
management of patients with COPD with anemia,
depending on the concentrations of iron, ferritin
and serum transferrin.
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