The Prevalence of Anemia of Chronic Disease in Patients With Spinal Cord Injuries and Pressure Ulcers and the Impact of Erythropoietin Supplementation on Wound Healing: A Descriptive Pilot Study

Abstract

Anemia of chronic disease (ACD) is thought to impair the responsiveness of erythroid progenitor cells, but research has shown treatment with recombinant human erythropoietin (rhuEPO) can improve patient hemoglobin levels and, subsequently, overall patient health status and quality of life. A prospective pilot study was designed to estimate the prevalence of ACD in outpatients with spinal cord injury (SCI) and chronic pressure ulcers (PUs) and examine the impact of rhuEPO on PU healing in this population. The charts of 49 SCI patients with PUs were reviewed; of those, 17 had anemia (hemoglobin <110 g/L). The prevalence of anemia in SCI patients with PUs was found to be approximately 35%. From these 17 potential participants, 5 had improved hemoglobin levels during the screening period (rendering them ineligible), 1 withdrew due to illness, and 7 died, leaving 4 participants to complete the study. Four patients (2 men, 2 women, average age 57 ± 16.5 years) ultimately were enrolled. Wound area and depth and cytokines were measured before, during, and after 6 weeks of treatment with rhuEPO, with a 3-month follow-up. Laboratory tests measuring hemoglobin, C-reactive protein, and prealbumin were used to monitor nutritional status and treatment response. No statistically significant changes were observed with treatment. Wound surface area and depth had mean decreases of 1.35 cm(2) and 0.58 cm, respectively, immediately post-treatment. Participants' elevated C-reactive protein levels (91.1-14.2 mg/L) decreased with rhuEPO treatment, but returned to baseline levels post-treatment (83.2-14.3 mg/L). Prealbumin levels were consistently low (range of 0.1-0.21 g/L). This research indicates rhuEPO treatment may improve some outcomes for ACD-SCI PU patients, but larger randomized controlled trials are required. The results of this study suggest the prevalence of ACD in the SCI outpatient population with PUs is at least 35%, and increased vigilance of patient nutrition is recommended.