Clinical Review: Treating Iron Defiency Anemia in Heart Failure

Table 1
Laboratory Tests to Diagnose Iron Deficiency Anemia in Heart Failure Patients

Laboratory Test
CBC • Red cell indices
• Reticulocyte count
• Evaluation of peripheral blood smear
Iron studies • Serum iron
• Transferrin
• Iron saturation
• Ferritin
• Total iron binding capacity
Renal fucntion • Serum creatinine
• Creatinine clearance
Inflammatory factors • CRP
Vitamin B • Vitamin B12
• Folate
Hormones • TSH

CBC-complete blood count; CRP=C-reactive protein; ESR=erythrocyte sedimentation rate
Nunez-Gil IJ, Peraira-Moral JR.  Anaemia in heart failure: intravenous iron therapy. European Society of Cardiology. E-Journal of Cardiology Practice. 2012;10:16.

Table 2
Laboratory Findings Associated with Iron Deficiency Anemia

Laboratory Parameter Result
Hemoglobin • <13g/dL (men)
• <12g/dL (women)
Mean corpuscular volume (MCV) • Low
Serum Ferritin • Low: <100ng/mL (absolute iron deficiency)
• Normal: 100-300ng/mL (functional iron deficiency)
Transferrin saturation (Tsat) • <20% accompanied by normal ferritin = functional iron deficiency

Table 3
Recommendations of Consensus Guidelines for Iron Supplementation in Patients with HF

Guideline Recommendation
2016 European Society of Cardiology Guidelines Intravenous FCM should be considered in symptomatic patients with HFrEF and iron deficiency (serum ferritin <100ng/L or ferritin between 100-299ng/L and transferrin saturation <20%) in order to alleviate HF symptoms and improve exercise capacity and quality of life
2017 American Heart Association/American College of Cardiology (AHA/ACC) Guideline Recommendations In patients with NYHA class II and III HF and iron deficiency (ferritin <100ng/mL or 100-300ng/mL if transferrin saturation is <20%), intravenous iron replacement might be reasonable to improve functional status and QoL.

FCM=ferric carboxymaltose; HF=heart failure; HFrEF=heart failure with reduced ejection fraction; QoL=quality of life

Ponikowski P, et al. Eur Heart J. 2016 Jul 14;37(27):2129-200.
Yancy CW, et al. Circulation. 2017 Aug 8;136(6):e137-e161. 

This article originally appeared on MPR