Anaemia, iron homeostasis and pulmonary hypertension: a review

Abstract

Anaemia is a highly prevalent condition, which negatively impacts on patients' cardiovascular performance and quality of life. Anaemia is mainly caused by disturbances of iron homeostasis. While absolute iron deficiency mostly as a consequence of chronic blood loss or insufficient dietary iron absorption results in the emergence of iron deficiency anaemia, inflammation-driven iron retention in innate immune cells and blockade of iron absorption leads to the development of anaemia of chronic disease. Both, iron deficiency and anaemia have been linked to the clinical course of pulmonary hypertension. Various mechanistic links between iron homeostasis, anaemia, and pulmonary hypertension have been described and current treatment guidelines suggest regular iron status assessment and the implementation of iron supplementation strategies in these patients. The pathophysiology, diagnostic assessment as well as current and future treatment options concerning iron deficiency with or without anaemia in individuals suffering from pulmonary hypertension are discussed within this review.

Keywords: Anaemia; Cardiovascular disease; Hypoxia; Iron deficiency; Pulmonary hypertension.

Fig. 1

Regulation of iron homeostasis in the human body

Fig. 2

Current concepts of the interconnection of iron homeostasis, anaemia and pulmonary hypertension. HIF hypoxia-inducible factor, NO nitric oxide, ET1 endothelin 1, PH pulmonary hypertension, ROS reactive oxygen species, RNS reactive nitrogen species, BMP bone morphogenetic protein, SMAD small mothers against decapentaplegic