**4. Conclusion**

*Erythrocyte - A Peripheral Biomarker for Infection and Inflammation*

patient without ID [8].

term [4, 11, 12].

**3. Management strategies**

greater morbidity, and mortality all could be predicted by the ID [8–10]. In fact ID has been shown to be a strong predictor for patient outcome than anaemia. ID without anaemia carries higher risk and poorer outcome compared to an anaemic

Earlier studies have suggested that anaemia is common in HF and carries worse prognosis yet measures to increase haemoglobin through red blood cell transfusion or erythropoiesis stimulating agents have not shown any beneficial effect in long

Unfortunately, this approach may not only did not improve the outcome in patients with HF but were associated with higher risk of adverse effects. This was demonstrated in a large study of public discharge database of 596456 patients admitted with heart failure [13]. Anaemia was present in 27% patient. The adjusted risk mortality was 70% higher in that receiving blood transfusion compared to 10% in those who did not. Thus, packed cell transfusion could be beneficial in acute

As regards treatment with erythropoiesis stimulating agents (ESA), a metaanalysis of 11 earlier studies comprising 794 patients showed benefit in peak oxygen consumption, NYHA class, BNP levels and QoL but no significant effect on allcause mortality [14]. Subsequently, a large study randomising 2278 patients with heart failure and anaemia but no iron deficiency when followed for 28 months did not confirm any benefit with the ESA darbopoetin, neither on the primary composite outcome of death from any cause, hospitalisation or worsening of heart failure. The lack of effect was equally present in subgroups as well as on the secondary

As against failure of blood replacement or ESA to demonstrate beneficial effect in heart failure, the scenario is different when it comes to treating ID with iron replacement. As mentioned earlier, ID is quite common in HF, affecting nearly 50% of patients with or without anaemia [8, 16–18]. Iron deficiency in patients with HF could be absolute or functional. Total iron is reduced in absolute ID but in the functional ID the total body iron is normal or increased but inadequate to fulfil the need of body tissues due to sequestration of the storage pools. Studies have shown that reversing ID in patient with or without anaemia and HF could improve patient outcomes [19], improve QoL and exercise capacity as well as improve depression

For the treatment of ID, it is important to consider the route of supplementation,

whether oral of intravenous (IV). The dietary iron is absorbed in the duodenum by the enterocytes and subsequently taken up into circulation, bound to transferrin [7]. However, in HF there is gastrointestinal oedema leading to impairment of absorption of iron and duodenal iron transport [10]. Also, in HF the hepcidin level increases which further reduced the iron levels [20]. Several studies and meta-analysis data have studied the role if intravenous iron therapy in patients with HF and ID [21], showing its beneficial effect on NYHA class, QoL and 6 min walk test. FAIR-HF (Ferinject Assessment in Patients with Iron Deficiency and Chronic Heart Failure) randomised 459 patients with ID to IV iron or saline. IV iron therapy improved the QoL, 6 min walk test, NYHA level significantly but all-cause mortality or first hospitalisation remained unchanged [21]. However, a subsequent study [22] with similar recruitment criteria conducted on 304 patients but monitored for longer duration (52 weeks) showed significant improvement in primary end point of 6 min walk test, the benefit sustaining for 1 year. There was improvement

anaemic states in heart failure but not in the chronic management.

outcomes of fatal MI, stroke, hypertension, and heart failure [15].

which is also prevalent in patients with HF.

**4**

In this book, we are describing the novel and traditional approaches taken by different scientists around the world to relate the status of an erythrocyte (Red blood cell) with chronic and acute conditions such as heart failure, which can be happening slowly over a period or can happen suddenly.

Heart failure is associated with anaemia about 50% of the patients. Iron deficiency is one of the important caused of anaemia in HF. This is predominantly due to lack of absorption of iron from the duodenum that is often inflamed/congested in heart failure. Thus, iron replacement is pivotal in the management of HF with ID. Intravenous iron Administration of intravenous iron has been proved to be beneficial in improving symptoms as well as prognosis in patients with HF and ID.

## **Author details**

Kaneez Fatima Shad1 \* and Nazar Luqman Bilgrami<sup>2</sup>

1 School of Life Sciences, University of Technology, Sydney, Australia

2 Austin Health, Heidelberg, Victoria, Australia

\*Address all correspondence to: ftmshad@gmail.com

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
