Document Detail

Low-density lipoprotein apheresis decreases ferritin, transferrin and vitamin B12, which may cause anemia in serially treated patients.
MedLine Citation:
PMID:  20438534     Owner:  NLM     Status:  MEDLINE    
Clinical observations revealed an increased prevalence of iron deficiency anemia without chronic bleeding in patients treated with serial low-density lipoprotein (LDL) apheresis. Since several different proteins are adsorbed by LDL apheresis beside pro-atherogenic lipoproteins, we examined the modification of the full blood count, plasma iron, vitamin B12, folic acid, and hemolysis by LDL apheresis. Nineteen patients (55 (50-59) years, 4 female, 15 male) undergoing chronic LDL apheresis due to mixed dyslipidemia (N = 17), homozygous familiar hypercholesterolemia (N = 1) or isolated elevated lipoprotein(a) (N = 1) were included in this study. They were treated with direct adsorption of lipoproteins (DALI; N = 6), heparin-induced LDL-precipitation (HELP; N = 7) or double filtration plasmapheresis (DFPP; N = 6). The patients' full blood count, iron metabolism (plasma iron, ferritin, transferrin, transferrin saturation), vitamins involved in erythropoiesis (vitamin B12 and folic acid), and markers of hemolysis (haptoglobin and free hemoglobin) were analyzed directly before and after LDL apheresis. A single LDL apheresis session significantly decreased the levels (reduction in the median [25(th)-75(th) percentiles] of: ferritin 9.8 [1.3-18] %; P = 0.004), transferrin (12.1 [10.0-15.96] %; P = 0.0005), and vitamin B12 (17.8 [16.2-20.8] %; P = 0.0005). Thereby, transferrin and vitamin B12 were decreased in all (N = 19) and ferritin in 74% (N = 14) of the patients. Twelve out of 19 patients (63.2%) had mild anemia despite iron administration in 14 out of 19 patients (73.7%). LDL apheresis had no significant influence on full blood count, plasma iron, transferrin saturation, folic acid, or hemolysis. Similar changes were observed in all LDL apheresis methods used. LDL apheresis significantly decreases ferritin, transferrin, and vitamin B12, suggesting an influence of serial LDL apheresis on erythropoiesis.
Carsten P Bramlage; Victor W Armstrong; Antonia Zapf; Peter Bramlage; Gerhard A Mueller; Michael J Koziolek
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Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy     Volume:  14     ISSN:  1744-9987     ISO Abbreviation:  Ther Apher Dial     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-05-04     Completed Date:  2010-08-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101181252     Medline TA:  Ther Apher Dial     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  136-42     Citation Subset:  IM    
Department of Medicine, Nephrology and Rheumatology, Georg-August-University Göttingen, Göttingen, Germany.
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MeSH Terms
Anemia / etiology*
Blood Component Removal / adverse effects*,  methods
Dyslipidemias / therapy*
Ferritins / metabolism
Heparin / chemistry
Hyperlipoproteinemia Type II / therapy
Lipoprotein(a) / blood
Lipoproteins, LDL / blood
Middle Aged
Plasmapheresis / methods
Transferrin / metabolism
Vitamin B 12 / metabolism
Reg. No./Substance:
0/Lipoprotein(a); 0/Lipoproteins, LDL; 11096-37-0/Transferrin; 68-19-9/Vitamin B 12; 9005-49-6/Heparin; 9007-73-2/Ferritins

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