Research Article: Prevalence of Anemia and Risk of Adverse Bleeding Effect of Drugs: Implication for Therapy

Date Published: February 28, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Ezekiel Uba Nwose.


This study aimed to evaluate the progress in reduction of prevalence of anemia in rural Australia. It also investigates the prevalence of hypoviscosity in anaemia with a view to determine the fraction of anaemic patients at risk of drug-inducible exacerbation of anemia. Archived clinical pathology data (N = 130, 354) for the period of 1999 to 2008 were utilized. The prevalence of anemia and hypoviscosity was evaluated by working out (i) the number that fell within anemia definition as a percentage of the population and (ii) the number that fell within hypoviscosity definition as a percentage of anemic patients. The prevalence in anemic diabetes and dyslipidaemia was further determined. There was progressive reduction in anemia from 6.1% to 3.2% over the ten years period. Prevalence of anemia is statistically significantly higher in males than in females (P < 0.0001), but protein level is lower in anemic females than in anemic males (P < 0.01). The results further show that up to 75% of anemic patients may benefit from NSAID or salicylates. This paper highlights differences between genders. It suggests more concerted effort in men's health and speculates a new factor to investigate in women's health.

Partial Text

There are a range of possible complications of anaemia. For example, it can predispose certain therapies to worsen bleeding complications. A perspective in practice that requires further acknowledgement perhaps is the risk of bleeding and/or exacerbated anaemia. Bleeding as a cause of anaemia is very well known and may not be dwelt much upon. When the issue of complications of anaemia comes, the points that easily come to mind are reduced oxygen transport by the blood, which feedforward to tissue hypoxia and fatigue. Others are reduced endurance or exercise capabilities and secondary organ dysfunction such as heart disease [1].

This work is part of a Translational Biomedical Science Research initiative. It is supported materially by the Albury South West Pathology, a unit of Western Pathology Cluster of NSW Health Australia. The Ethics Committee of the Area Health Service granted request through the Operations Manager for the use of deidentified data. Ten years deidentified archived clinical pathology data for the period of January 1999 to December 2008 constitutes the database [17]. Selection was limited to those that were concomitantly tested for haematocrit and total proteins from the same phlebotomy collection time. WBV at high shear stress was determined from haematocrit and total proteins as previously published [18].

The female population included “n = 117, 746”, out of which 2,796 had anemia. The male population included “n = 112, 608”, out of which 6,283 had anemia (Table 2). There is evidence of progressive reduction in anemia over the ten years period from average of 6.1% in 1999 down to 3.2% by 2008 (Figure 1). It is observed that prevalence is statistically significantly higher in males than in females (P < 0.0001). The first objective of this study was to determine progress in reduction of anemia over a period of ten years using pathology-based evidence. Given that prevalence of anemia depends on the haematocrit thresholds used in the definition [20], it was noted that the World Health Organization thresholds for diagnosis of anemia were different from the reference ranges used by the pathology (Table 1). Therefore, discretion was employed to use pathology's reference values in order to avoid underestimation of the prevalence of anemia in adults. This paper indicates that hypoviscosity driven by low proteinaemia is highly prevalent in anemia. The speculation and suggestion here are that laboratory monitoring of stasis using proteinaemia and/or WBV measures should provide evidence-based pathology for risk of exacerbating anemia in anemic patients.   Source: