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Eur J Haematol. 2019 Mar;102(3):235-240. doi: 10.1111/ejh.13198. Epub 2019 Jan 1.

Inflammatory functional iron deficiency common in myelofibrosis, contributes to anaemia and impairs quality of life. From the Nordic MPN study Group.

Author information

1
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
2
Department of Hematology, University Hospital Linkoping, Linkoping, Sweden.
3
Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
4
Institute for Inflammation Research, Copenhagen University Hospital, Copenhagen, Denmark.
5
Department of Research, Østfold Hospital, Sarpsborg, Norway.
6
Department of Hematology, Zealand University Hospital, Roskilde, Denmark.
7
Department of Hematology, Ullevål Hospital, Oslo, Norway.
8
Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark.
9
Hematology Section, Specialist Medicine, NU Hospital Group, Uddevalla, Sweden.

Abstract

OBJECTIVES:

The study investigates the hypothesis that inflammation in myelofibrosis (MF) like in myeloma and lymphoma, may disturb iron distribution and contribute to anaemia.

METHODS:

A cross-sectional study of 80 MF and 23 ET patients was performed.

RESULTS:

About 35% of anaemic MF patients had functional iron deficiency (FID) with transferrin saturation <20 and normal or elevated S-ferritin (<500 µg/L). In ET, FID was rare. In MF patients with FID, 70.6% were anaemic, vs 29.4% in patients without FID (P = 0.03). Hepcidin was significantly higher in MF patients with anaemia, including transfusion-dependent patients, 50.6 vs 24.4 µg/L (P = 0.01). There was a significant negative correlation between Hb and inflammatory markers in all MF patients: IL-2, IL-6 and TNF-α, (P < 0.01-0.03), LD (P = 0.004) and hepcidin (P = 0.03). These correlations were also seen in the subgroup of anaemic MF patients (Table ). Tsat correlated negatively with CRP (P < 0.001). Symptom burden was heavier in MF patients with FID, and MPN-SAF quality of life scores correlated with IL-6 and CRP.

CONCLUSIONS:

The inflammatory state of MF disturbs iron turnover, FID is common and contributes to anaemia development and impairment of QoL. Anaemic MF patients should be screened for FID.

KEYWORDS:

Myelofibrosis; anaemia of inflammation; cytokines; functional iron deficiency

PMID:
30472746
DOI:
10.1111/ejh.13198

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