Monday, October 31, 2005
Archives of Internal Medicine has several articles on anemia in its current issue, including another study tying anemia to mortality in the elderly, and one questioning whether anemia is a risk factor for mortality in CHF independent of comorbidities.
The most interesting, though, is a paper on the association of anemia with energy and physical functioning in HIV/AIDS. It is a prospective cohort study which looked at anemia in adults with HIV (the data was taken from ~1400 HIV patients who were being followed in a study on ocular complications of AIDS). Essentially the patients were followed, data was gathered, and the authors looked at both the presence & absence of anemia as well as the absolute hemoglobin level and correlated that with energy level & physical functioning. CD4#, viral load, age, sex, race, education, and HIV risk factors were controlled for. What was interesting was not that they found that the presence of anemia was associated with worse energy/functioning but that there was a linear relationship between hemoglobin level & well-being. That is, even for those who weren't anemic (Hgb >13g/dL for men; 12 for women)--the higher the Hgb the higher the energy level. This, currently, probably means very little for practice (who is going to pay for Epo for people with 'crits of 40?), but it does suggest leaving 'relative anemia' on the differential for fatigue in HIV patients with low-normal hemoglobins.