Changes of hematological indices among patients with chronic heart failure with low ejection fraction of the left ventricle with comorbid iron deficiency

Abstract

Objective is to determine changes in hematological indices with a view to erythrocytic parameters depending on the type and degree of iron deficiency among patients with chronic heart failure with low ejection fraction of the left ventricle. Material and methods. The main clinical area of the study was 122 patients with chronic heart failure (CHF) of the II–III functional class (FC) by NYHA hypertensive in combination with ischemic etiology with low ejection fraction (low EF) of the left ventricle (LV) and comorbid iron metabolism disorder. Among these patients there were 60 patients with latent iron deficiency (ID) and 62 patients with iron deficiency anemia (IDA). The comparison group consisted of 30 patients with CHF low EF without ID. All patients underwent laboratory tests with the determination of red blood counts and standard calculated erythrocyte indices — MCV, MCH, MCHC. The main biochemical indicators were used to evaluate the state of iron metabolism in the body: the level of serum iron (SI) of the blood serum, the level of ferritin, the total iron binding capacity of the blood serum (IBCS), and estimate indicator of transferrin saturation with iron (TSI). Results. According to the analysis of the ferrokinetic parameters among 122 patients with HF low EF, there were 18 (14,8%) with functional ID, 42 (34,4%) with latent ID, 25 (20,5%) with mild degree of IDA and 37 patients (30,3%) with moderate degree of IDA. Clinical and laboratory examination of patients with comorbid absolute latent ID and mild IDA, moderate degree made it possible to detect a gradual decrease in CI, MCV, MCH, MCHC, ferritin, TSI, and an increase in IBCS in the wake of ID rising. And also a significant difference in the mean values of these indices, except for MCHC, compared with the group of patients with HF low EF without ID. A significant reduction in MCHC was observed only in the group of patients with concomitant IDA of moderate severity. Between the groups of patients with HF low EF with functional ID and a group of patients HF low EF without ID without a reliable difference of the studied indices was not found. Conclusions. Among patients with chronic heart failure and reduced left ventricular ejection fraction with growth of iron deficiency to iron deficiency anemia of moderate degree color indicator, MCV, MCH, MCHC are gradually decreasing. With absolute latent iron deficiency and iron deficiency anemia, the erythrocyte indices MCV and MCH are significantly lower than with functional and in the absence of iron imbalance, which allows using these indices not only to determine the manifest, but also the hidden absolute iron deficiency. For the verification of functional iron deficiency, it is necessary to study and use more sensitive calculated erythrocytic parameters.