Etiopatogeneza, učestalost i značaj anemije u srčanoj insuficijenciji

Pregledni rad 

Snežana Ćirić Zdravković

63–71

https://doi.org/10.5937/medrec2502063C

Apstrakt

Anemija i nedostatak gvožđa česti su komorbiditeti kod pacijenata sa srčanom insuficijencijom (HF). Kod pacijenata sa HF, prevalencija anemije i nedostatka gvožđa varira u zavisnosti od ispitivane populacije. U SOLVD studiji, 22% pacijenata imalo je hematokrit  ≤ 39%, a 4% je imalo vrednosti ispod 35%. Čini se da se incidenca anemije povećava sa pogoršanjem funkcionalne klase (sa 9% za NYHA klasu na 79% za NYHA klasu IV). Simptomi smanjene isporuke kiseonika usled anemije generalno se javljaju samo kod teške anemije, ali se mogu javiti i kod manje ozbiljno sniženih nivoa hemoglobina kod pacijenata sa HF. Dijagnostika anemije kod pacijenata sa HF treba da uključi razmatranje etiologije povezane sa HF, ali i druge uzroke. Predloženo inicijalno testiranje uključuje: kompletnu krvnu sliku, uključujući indekse crvenih krvnih zrnaca, broj retikulocita i procenu razmaza periferne krvi, merenje gvožđa, C-reaktivni protein, sedimentaciju, nivoe vitamina B12 i folata u serumu. Nedostatak gvožđa treba korigovati i istražiti uzrok. Kod pacijenata sa HF koji nemaju simptome koji se mogu pripisati anemiji, predlaže se upotreba restriktivne strategije transfuzije crvenih krvnih zrnaca. Intravensko davanje gvožđa dovodi do poboljšanja simptoma i poboljšanja prognoze u smislu smanjenja broja hospitalizacija. Takvi benefiti nisu uočeni kod bolesnika koji dobijaju oralne preparate gvožđa. Prisustvo anemije kod srčane slabosti je prediktor loše prognoze, te je treba dijagnostikovati i adekvatno lečiti.

Ključne reči: anemija, srčana slabost, nedostatak gvožđa

Etiopathogenesis, Frequency and Significance of Anemia in Heart Failure

Ceo tekst 

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