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The prevalence, course, and characteristics of chronic anemia after heart and lung transplantation
1Department of Research Haematology, Harefield Hospital, Middlesex, England.
Insights
Anemia is common after heart and lung transplants, affecting 31% of patients six months post-surgery. This chronic anemia, linked to azathioprine sensitivity and dyshemopoiesis, requires further investigation for effective management.
Area of Science:
- Transplantation Medicine
- Hematology
- Immunosuppression Therapy
Background:
- Anemia is a frequent complication following heart and lung transplantation (HLT).
- Previous studies indicate varying prevalence, necessitating further investigation into underlying causes.
- Understanding anemia post-HLT is crucial for improving long-term patient outcomes.
Purpose of the Study:
- To investigate the prevalence and characteristics of anemia in heart and lung transplant recipients.
- To identify potential causes and contributing factors to post-transplant anemia.
- To explore the relationship between anemia and immunosuppressive therapy, specifically azathioprine.
Main Methods:
- Retrospective analysis of 99 heart and lung transplant recipients' data.
- Detailed hematological and biochemical assessments in 16 representative patients.
- Bone marrow aspirate analysis in 10 patients.
Main Results:
- 31% of HLT recipients had significant anemia at six months, persisting in 18% at two years.
- Anemia was unrelated to original diagnosis, immunosuppression, or acute rejection.
- Patients showed signs of anemia of chronic disease and dyshemopoiesis, with some evidence of autoantibodies and lymphoid cell activation.
Conclusions:
- Anemia is a significant and persistent issue after heart and lung transplantation.
- The etiology appears multifactorial, involving anemia of chronic disease and dyshemopoiesis.
- Further research is needed to elucidate the exact mechanisms and develop targeted therapies.
Abstract:
A retrospective study of the 99 surviving heart and lung transplant (HLT) recipients at one center showed that 31% had significant anemia (hemoglobin less than 100g/L) six months after transplantation. Chronic anemia persisted in 18% of HLT recipients two years posttransplantation. A similar study of 100 heart transplant recipients showed no unexplained anemic patients. The prevalence of anemia after HLT was unrelated to the original diagnosis, immunosuppression, or acute rejection. All HLT recipients appeared to be unduly sensitive to the myelosuppressive effects of azathioprine. Detailed studies in 16 representative patients showed a normochromic, anisocytotic anemia with normal reticulocyte counts, B12 and folate levels, and haptoglobin levels and appropriate erythropoietin levels--but increased ESRs, low/normal iron levels and low/normal total iron binding capacity, normal or raised ferritin levels, and autoantibodies in 4 (25%). Bone marrow aspirates in 10 patients showed dyshemopoiesis out of proportion to the degree of anemia and colonies of activated lymphoid cells. The cause for this anemia appears to be a combination of anemia of chronic disease and dyshemopoiesis, both of uncertain etiology.