The impact of anemia on neurological and functional state in patients in acute stroke – preliminary report
More details
Hide details
Katedra i Klinika Neurologii, Wydział Nauk o Zdrowiu w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
Klinika Chorób Wewnętrznych i Metabolicznych, Wydział Nauk o Zdrowiu w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
Anetta Lasek-Bal   

Katedra I Klinika Neurologii, Wydział Nauk o Zdrowiu w Katowicach, Śląski Uniwersytet Medyczny w Katowicach, ul. Ziołowa 45/47, 40-635 Katowice, tel.: +48 32 359 83 06
Ann. Acad. Med. Siles. 2016;70:281–285
Anemia is a risk factor for cerebrovascular events. The aim of this study was to evaluate the prevalence of anemia among patients who underwent a first-ever stroke and its impact on the neurological and functional state in the acute phase of stroke.

Material and methods:
The prospective study encompassed 109 patients (53 women) aged 72.8 ± 11.12 after stroke. We analyzed their neurological state on the first day after stroke by NIHSS and their functional status on the 14th day after the onset of stroke by the modified Rankin scale among patients with anemia and without anemia.

Anemia was found in 34 patients, in 15 women and 19 men; 8 patients aged ≤ 65 years. The neurological deficit according to NIHSS, functional status at the level of 3–5 by mRS and death did not differ significantly between the analyzed groups. An independent predictor of a worse functional status on the 14th day after stroke or death in Group 1 included the neurological state on the 1st day following stroke.

Anemia appeared in approximately 1/3 patients suffering a stroke. Slight or moderate anemia in the acute period of stroke did not significantly influence the neurological or functional status in the acute phase of stroke. The neurological state on the first day is an independent factor of a poor prognosis in patients with anemia in short-term follow-up.

Saxena K., Ranalli M., Khan N., Blanchong C., Kahwash S.B. Fatal stroke in a child with severe iron deficiency anemia and multiple hereditary risk factors for thrombosis. Clin. Pediatr. 2005; 44: 175–180.
Roger V.L., Go A.S., Lloyd-Jones D.M., Benjamin E.J., Berry J.D., Borden W.B., Bravata D.M., Dai S., Ford E.S., Fox C.S., Fullerton H.J., Gillespie C., Hailpern S.M., Heit J.A., Howard V.J., Kissela B.M., Kittner S.J., Lack-land D.T., Lichtman J.H., Lisabeth L.D., Makuc D.M., Marcus G.M., Marelli A., Matchar D.B., Moy C.S., Mozaffarian D., Mussolino M.E., Nichol G., Paynter N.P., Soliman E.Z., Sorlie P.D., Sotoodehnia N., Turan T.N., Virani S.S., Wong N.D., Woo D., Turner M.B. Heart disease and stroke statistics – 2012 update: a report from the American Heart Association. Circulation 2012; 125: e2–e220.
Maguire J.L., deVeber G., Parkin P.C. Association between iron-deficiency anemia and stroke in young children. Pediatrics 2007; 120: 1053–1057.
Azab S.F., Abdelsalam S.M., Saleh S.H., Elbehedy R.M., Lotfy S.M., Esh A.M., Srea M.A., Aziz K.A. Iron deficiency anemia as a risk factor for cerebrovascular events in early childhood: a case-control study. Ann Hematol. 2014; 93: 571–576.
Tegos T.J., Kalodiki E., Daskalopoulou S.S., Nicolaides A.N. Stroke: epidemiology, clinical picture, and risk factors – Part I of III. Angiology. 2000; 51: 793–808.
Driscoll M.C., Hurlet A., Styles L., McKie V., Files B., Olivieri N., Pegelow C., Berman B., Drachtman R., Patel K., Brambilla D. Stroke risk in siblings with sickle cell anemia. Blood. 2003; 101: 2401–2404.
Huang W.Y., Chen I.C., Meng L., Weng W.C., Peng T.I. The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke. J. Clin. Neurosci. 2009; 16: 645–649.
Nybo M., Kristensen S.R., Mickley H., Jensen J.K. The influence of anaemia on stroke prognosis and its relation to N-terminal pro-brain natriuretic peptide. Eur. J. Neurol. 2007; 14: 477–482.
Tanne D., Molshatzki N., Merzeliak O., Tsabari R., Toashi M., Schwammenthal Y. Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study. BMC Neurol. 2010; 10: 22.
The World Bank. World Development Report 1993. Investing in health. Oxford University Press, Oxford 1993.
Jauch E.C., Saver J.L., Adams H.P. Jr, Bruno A., Connors J.J., Demaerschalk B.M., Khatri P., McMullan P.W. Jr, Qureshi A.I., Rosenfield K., Scott P.A., Summers D.R., Wang D.Z., Wintermark M., Yonas H. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44: 870–947.
Beutler E., Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 2006; 107: 1747–1750.
Young F.B., Weir C.J., Lees K.R. GAIN International Trial Steering Committee and Investigators. Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke trials. Stroke 2005; 36: 2187–2192.
Weisscher N., Vermeulen M., Roos Y.B., de Haan R.J. What should be defined as good outcome in stroke trials; a modified Rankin score of 0–1 or 0–2? J. Neurol. 2008; 255: 867–874.
Sabatine M.S., Morrow D.A., Giugliano R.P., Burton P.B., Murphy S.A., McCabe C.H., Gibson C.M., Braunwald E. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005; 111: 2042–2049.
Lawler P.R., Filion K.B., Dourian T., Atallah R., Garfinkle M., Eisenberg M.J. Anemia and mortality in acute coronary syndromes: a systematic review and meta-analysis. Am. Heart J. 2013; 165: 143–153.
Bowling C.B., Muntner P., Bradbury B.D., Kilpatrick R.D., Isitt J.J., Warriner A.H., Curtis J.R., Judd S., Brown C.J., Allman R.M., Warnock D.G., McClellan W. Low hemoglobin levels and recurrent falls in U.S. men and women: prospective findings from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Am. J. Med. Sci. 2013; 345: 446–454.
Penninx B.W., Pahor M., Woodman R.C., Guralnik J.M. Anemia in old age is associated with increased mortality and hospitalization. J. Gerontol. A. Biol. Sci. Med. Sci. 2006; 61: 474–479.
Penninx B.W., Pluijm S.M., Lips P., Woodman R., Miedema K., Guralnik J.M., Deeg D.J. Late-life anemia is associated with increased risk of recurrent falls. J. Am. Geriatr. Soc. 2005; 53: 2106–2111.
Shah R.C., Wilson R.S., Tang Y., Dong X., Murray A., Bennett D.A. Relation of hemoglobin to level of cognitive function in older persons. Neuroepidemiology 2009; 32: 40–46.
Dong X., Mendes de Leon C., Artz A., Tang Y., Shah R., Evans D.A. population-based study of hemoglobin, race, and mortality in elderly persons. J. Gerontol. A. Biol. Sci. Med. Sci. 2008; 63: 873–878.
Culleton B.F., Manns B.J., Zhang J., Tonelli M., Klarenbach S., Hemmelgarn B.R. Impact of anemia on hospitalization and mortality in older adults. Blood 2006; 107: 3841–3846.
Diedler J., Sykora M., Hahn P., Heerlein K., Schölzke M.N., Kellert L., Bösel J., Poli S., Steiner T. Low hemoglobin is associated with poor functio-nal outcome after non-traumatic, supratentorial intracerebral hemorrhage. Crit. Care. 2010; 14: R63.
Hemphill J.C., Bonovich D.C., Besmertis L., Manley G.T., Johnston S.C. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001; 32: 891–897.
Kumar M.A., Rost N.S., Snider R.W., Manley G.T., Johnston S.C. Anemia and hematoma volume in acute intracerebral hemorrhage. Crit. Care. Med. 2009; 37: 1442–1447.
Dubyk M.D., Card R.T., Whiting S.J., Boyle C.A., Zlotkin S.H., Paterson P.G. Iron deficiency anemia prevalence at first stroke or transient ischemic attack. Can. J. Neurol. Sci. 2012; 39(2): 189–195.
Koennecke H.C., Belz W., Berfelde D., Endres M., Fitzek S., Hamilton F., Kreitsch P., Mackert B.M., Nabavi D.G., Nolte C.H., Pöhls W., Schmehl I., Schmitz B., von Brevern M., Walter G., Heuschmann P.U. Factors in-fluencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology 2011; 77: 965–972.
Kim J.S., Kang S.Y., Grines C.L., Cox D.A., Garcia E., Mehran R., Tcheng J.E., Griffin J.J., Guagliumi G., Stuckey T., Turco M., Cohen D.A., Negoita M., Lansky A.J., Stone G.W. Bleeding and subsequent anemia: a precipitant for cerebral infarction. Eur. Neurol. 2000; 43: 201–208.
Nikolsky E., Aymong E.D., Halkin A. Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Inve-stigation to Lower Late Angioplasty Complications (CADILLAC) Trial. J. Am. Coll. Cardiol. 2004; 44: 547–553.