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Derar H. Abdel-Qader^*✉ , Salah AbuRuz , Hana M. Sawan , Nadia Al Mazrouei , Osama Mohamed Ibrahim , Salim Hamadi , Jennifer Silverthorne

1. Faculty of Pharmacy & Medical Sciences, University of Petra, Amman, Jordan.
2. Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, The United Arab Emirates University, Al Ain, United Arab Emirates.
3. Faculty of Pharmacy, Pharmaceutical Sciences Department, Zarqa University, Amman, Jordan.
4. Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, United Arab Emirates.
5. Department of Clinical Pharmacy, School of Pharmacy, New Giza University, Egypt.

6. Division of Pharmacy & Optometry, The University of Manchester, Manchester, UK.

Abstract

Congestive heart failure (CHF) frequently coexists with anemia, which is associated with negative results. To the best of our knowledge, this was the first study to evaluate the characteristics of iron metabolism markers in patients with CHF and anemia in Jordan. The current investigation included 150 CHF patients divided into 3 subgroups: 50 patients with absolute iron deficiency (AID) where (serum ferritin (SF) <100 µg/L), 50 patients with functional iron deficiency (FID) where (SF=100-300 µg/L and iron transferrin saturation coefficient (ITSC) <20%), and 50 other patients having anemia without ID. Among the total studied patients, hemoglobin values corresponded to a mild degree of anemia. Serum iron (SI), serum ferritin (SF), and soluble transferrin receptors (STR) matched reference levels, transferrin (TR) was below normal, and the median iron transferrin saturation coefficient (ITSC) <20% is an indication of ID. SI, SF, and TR conformed to reference values. TR, STR, ITSC, total iron-binding capacity (TIBC), endogenous erythropoietin (EPO), and C-reactive protein (CRP) all showed statistically significant variations among the studied subgroups, indicating important variations in iron metabolism of these subgroups. In the AID subgroup, CRP and hepcidin values were minimal, indicating a minor role in inflammation.

Anemia in individuals with CHF was normocytic and normochromic, with low erythropoietin release and significant amounts of CRP and hepcidin. At later phases, iron supplements should be recommended for these two subgroups.

Keywords: Heart failure, Anemia, Iron deficiency, Ferritin, Erythropoietin, Hepcidin

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