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Anemia Biomarkers in Pregnant People with Pyelonephritis
Noor K Al-Shibli1,2, Kristin E Weaver1, Matthew R Grace3
1Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
American Journal of Perinatology
|March 27, 2025
Summary
Pregnant patients with pyelonephritis show elevated erythropoietin (EPO) levels, suggesting a link to renal inflammation rather than iron deficiency or hemolysis. This finding highlights potential issues with red blood cell production during infection in pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Nephrology
- Hematology
Background:
- Anemia affects 30-50% of pregnancies complicated by pyelonephritis, with unclear etiology.
- Erythropoietin (EPO), crucial for red blood cell production, responds to hypoxia and inflammation.
- Limited data exists on EPO levels in pregnant patients with renal inflammation.
Purpose of the Study:
- To compare erythropoietin (EPO) levels in pregnant patients with acute pyelonephritis to trimester-specific norms.
- To assess iron deficiency and hemolysis markers as potential causes of anemia in this cohort.
Main Methods:
- Prospective cohort study of pregnant individuals diagnosed with pyelonephritis.
- Blood samples collected within 72 hours of diagnosis for EPO, iron, transferrin, LDH, and haptoglobin.
- Statistical comparison of EPO levels to established non-infected pregnancy values.
Main Results:
- Anemia was present in 35.3% of the 17 pyelonephritis patients (second/third trimester).
- EPO levels were significantly higher in pyelonephritis patients (48.6 mU/mL) versus controls (10.6 mU/mL, p=0.0001).
- Iron and haptoglobin levels were mostly normal; LDH levels were normal in all patients.
Conclusions:
- Pregnant patients with pyelonephritis exhibit significantly elevated EPO levels compared to normative data.
- Findings suggest elevated EPO may relate to renal inflammation and ineffective erythropoiesis, not solely iron deficiency or hemolysis.
- This pilot study indicates a potential link between renal inflammation and altered red blood cell production in pregnancy.
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