5/ Additional evidence that iron deficiency alone can cause symptoms comes from studies of polycythemia vera, a condition associated with high rates of:
9/ These findings help explain why iron is effective in the treatment of heart failure, even without anemia. In particular, one meta-analysis reported a...
11/ There is undoubtedly a lot more to it. But, the key idea is that iron has roles well beyond being a component of hemoglobin and allowing for oxygen delivery.
💥In fact, one study estimated that 6.5% of all human enzymes are iron-dependent!💥
12/12
➤Iron deficiency can lead to symptoms (e.g., fatigue) independent of hemoglobin
➤This results from iron's key role in many key human enzymes, particularly those required for mitochondrial function
➤Iron supplementation improves outcomes in heart failure
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You are seeing a patient recently diagnosed with heart failure and started on GDMT. You notice that their hemoglobin (HGB) has increased (12 → 13 g/dL) in the intervening weeks.
🤔Which medication is the likely cause of this increase in HGB?
2/12 - An Answer
Empagliflozin
💡All SGLT2 inhibitors have been associated with an increase in hematocrit/hemoglobin soon after initiation.
The average increase is 2.3% in hematocrit and 0.6 g/dL in hemoglobin.
The effect of SGLT2 inhibitors on HCT/HGB has been noted since the very first randomized control trial of dapagliflozin, published in 2010.
Initially, investigators assumed this was related to the diuretic effect of these drugs (i.e., a reduction in plasma volume led to an increase in HCT/HGB).
3/ The mutation in the Factor V gene conferring resistance to activated protein C was detailed the following year by a group in Leiden, The Netherlands.
@CircAHA 2/
Patient One had chronic anemia with a hemoglobin 1.5 g/dL. You'll see that before receiving blood they had the following cardiac parameter:
• HR 100 (elevated)
• Cardiac index 8.9 (elevated)
• Stroke index 89 (elevated)
@CircAHA 3/
After transfusion to a hemoglobin of 10 g/dL, the following changes were noted:
• HR 100 (elevated but unchanged)
• Cardiac index 3.4 (decreased and now normal)
• Stroke index 34 (decreased and now normal)