High prevalence of anemia after cardiac transplantation in children
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Published on: September 6, 2017
N D Embleton1, J J O'Sullivan, J R Hamilton
1Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, England.
Insights
Anemia is common in children after heart transplants, but it
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Hematology
Background:
- Chronic anemia is prevalent in adult heart transplant recipients.
- The prevalence and causes of anemia in pediatric heart transplant patients are not well-defined.
- Iron deficiency is common in healthy children and may contribute to anemia post-transplant.
Purpose of the Study:
- To determine the prevalence of chronic anemia in well pediatric cardiac transplant survivors.
- To investigate the underlying causes of anemia in this population.
- To specifically assess the role of iron deficiency in post-cardiac transplant anemia.
Main Methods:
- Studied 20 children (7 months to 16 years) post-cardiac transplantation.
- All participants were clinically well, 4 months to 6 years post-transplant.
- Assessed anemia prevalence and initiated iron supplementation in anemic children.
Main Results:
- 14 out of 20 children (70%) were anemic.
- Low serum iron and erythropoietin levels were observed in most anemic children.
- Only one child showed improvement with iron supplementation; hemoglobin levels remained low.
Conclusions:
- Anemia is highly prevalent in pediatric cardiac transplant recipients.
- Anemia is typically not caused by iron deficiency, despite low iron levels.
- Anemia of chronic disease, potentially linked to inflammation or cyclosporine effects on erythropoietin, is likely the primary cause.
Background:
Chronic anemia is common in adults after successful cardiac transplantation. However, the prevalence of anemia in children after cardiac transplantation is uncertain. The purpose of this study was to investigate the prevalence and causes of chronic anemia in well children after cardiac transplantation and in particular to define the role, if any, of iron deficiency, which is important and relatively common in normal children.
Methods:
Twenty children (ages 7 months to 16 years) who were well 4 months to 6 years after cardiac transplantation were studied. Fourteen children (70%) were anemic and enrolled in a prospective trial of iron supplementation.
Results:
In the majority of children, serum iron and erythropoietin levels were low, although serum ferritin and zinc protoporphyrin levels tended to be normal or high. Only one child demonstrated a definite response to iron supplementation, although the hemoglobin level remained low.
Conclusions:
Anemia is highly prevalent in this population, and, despite the presence of low serum iron and transferrin saturation, anemia is not usually due to iron deficiency. Although the diagnosis of iron deficiency in this group is difficult and must not be missed, inappropriate therapy should be avoided. In the majority of children, there appears to be an anemia of chronic disease which may be secondary to chronic inflammation or an effect of cyclosporine on erythropoietin production.
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