Anemia is well-known hematologic abnormality in patients with pulmonary tuberculosis (TB). However, the prevalence of anemia varied in each study and the evolution of anemia with short course anti-TB chemotherapy has been not known yet. The aim of this study was to elucidate the prevalence, risk factors, and progression of anemia during the treatment in patients with TB.
1063 patients who took anti-tuberculosis medication with diagnosis of TB from June 1st, 2001 to May 31st, 2002 in Seoul National University Hospital, Seoul, South Korea were enrolled. We retrospectively reviewed their medical records including the levels of hemoglobin, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin concentration through the treatment period. Anemia was defined as hemoglobin concentration less than 13g/dL in men and 12g/dL in women.
Among 1063 patients with TB, 166 patients were excluded because they had other causes of anemia other than TB. Among remaining 897 patients, 293(32.7%) patients had anemia initially. Anemia was usually mild, no man had hemoglobin concentration less than 8.0g/dL and no woman less than 7.0g/dL. Normocytic and normochromic anemia was most common and identified in 211 (72%) of patients with anemia. Microcytic and hypochromic anemia was next common (26 patients, 9%). Female sex (p=0.007, OR=1.11-1.98) and old age (p<0.001, OR=1.81-3.54) were associated with the presence of anemia while type of tuberculosis was not related with risk factor of anemia (p=0.266, OR=0.87-1.67). In 180 (61.4%) patients anemia was resolved and the mean of period from initiation of treatment to resolution of anemia is 118.8 (5-321) days.
Mild anemia is common hematologic complication of TB and usually normocytic and normochromic pattern. The risk factors for presence of anemia were female sex and old age. In 60% of patients, anemia was resolved with anti-TB treatment.
Anemia associated with TB usually has benign course, so we can observe it with treatment of TB. If anemia is severe (Hb<8.0g/dl for men, Hb<7.0 for women), we should consider cause of anemia other than TB. Table1.
Distribution of HemoglobinSexTotalMaleFemale∼7.0000Hemoglobin (g/dl)7.1∼8.00338.1∼9.073109.1∼10.015264110.1∼11.026457111.1∼12.0388312112.1∼12.95913018913∼339123462Total484413897Table2.
Risk Factors of AnemiaProportion of anemiaOdds ratio (95% C.I.)Significance (p value)SexMale: 28%Female: 37%1.112 - 1.980.007Age; <65 vs >65<65: 28%>65: 49%1.805-3.5390.001Pulmonary vs Extrapulmonary TBPulm: 32%Extra: 35%0.866-1.6860.266
S. Lee, None.