Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device

Christopher N. Pierce, Douglas F Larson

Research output: Contribution to journalArticle

153 Citations (Scopus)

Abstract

Mechanical circulatory assist devices (MCADs) are increasingly utilized independently of cardiac transplantation in the management of heart failure. Though MCAD use incorporates inherent mechanical risks, the inevitable onset of chronic anemia, with its associated morbidity and mortality, is also a significant concern. MCAD support has been correlated with elevated plasma levels of inflammatory cytokines TNF-α, IL-1β, and IL-6, which have separately been found to inhibit erythropoietin (Epo)-induced erythrocyte (RBC) maturation. Previous analysis of hematological parameters for MCAD-supported patients concluded that an amplified inflammatory response impedes RBC proliferation and recovery from hemolytic anemia. Additional analysis may bolster this assertion. Hemoglobin concentration (HC), RBC distribution width (RDW), mean cell volume (MCV), and cardiac index were retrospectively analysed for 78 MCAD-supported patients implanted for greater than 30 days at the University of Arizona Health Sciences Center from 1996 to 2002. Analysis confirms that the HC, a conventional marker for anemia, declines with MCAD placement and remains below the clinically defined, minimum normal value. Inversely, the RDW rises above maximum normal measure, signifying an increased fraction of juvenile RBCs. The MCV remains unchanged and within normal limits, demonstrating adequate substrate for RBC formation. MCAD performance also stabilizes as adequate perfusion returns. These results further support our previously published conclusion that a sufficient response of erythropoiesis occurs in reaction to the onset of anemia by an increased production of immature RBCs. However, the cells never fully mature and join circulation. The patient's inflammatory cytokine response to the implanted device most likely mediates the chronic MCAD-induced anemia by inhibition of Epo effects.

Original languageEnglish (US)
Pages (from-to)83-90
Number of pages8
JournalPerfusion
Volume20
Issue number2
DOIs
StatePublished - 2005

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Erythropoiesis
Hemoglobin
Cytokines
Equipment and Supplies
Anemia
Health
health science
Plasmas
Recovery
morbidity
proliferation
Erythrocyte Indices
Substrates
mortality
Erythropoietin
Hemoglobins
management
performance
Values
Hemolytic Anemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device. / Pierce, Christopher N.; Larson, Douglas F.

In: Perfusion, Vol. 20, No. 2, 2005, p. 83-90.

Research output: Contribution to journalArticle

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