Article Text

Download PDFPDF

  1. Sergii Shevchuk,
  2. Oxana Zviahina
  1. National Pirogov Memorial Medical University, Vinnytsya, internal medicine, Vinnytsya, Ukraine


Background: Anemia is one of the most common extraarticular manifestations in patients with ankylosing spondylitis (AS). According to various sources, from 18.5 to 45.8% of patients with AS have anemia. In the pathogenesis of anemic syndrome in the AS, a leading role is given to proinflammatory cytokines (IL-1, IL-6, and TNF-alpha), which is associated with the development of anemia of chronic disease (ACD) in this category of patients. Another type of anemia in patients with AS is iron deficiency anemia (IDA), and the relationship between the latter and the ACD varies significantly according to various literature data. As for other types of anemia in the AS, they are represented by anemia caused by drugs.

Objectives: The purpose of the work was to investigate the prevalence of anemia in the Ukrainian population of patients with AS and evaluate the hematopoiesis in patients with the main types of it.

Methods: The group with anemia included patients whose haemoglobin levels were below 120 g/l. The diagnosis of AS was determined according to the modified New York criteria (1984). Laboratory methods of research (general analysis of blood, erythrocytes, haemoglobin, color index, serum iron, total iron binding capacity (TIBC) included in the list of standard examinations of patients were performed according to standard methods. To verify the diagnosis of ACD, ferritin (FN) and levels of soluble transferrin receptor (sTfR) were determined.

Results: 118 patients with AS were included into the study, 11 (32.3%) females and 23 (67.7%) males. It was found that 34 patients (28.8%) had anemia. Anemia of mild degree was manifested in 27 (79.4%) patients and with moderate severity - 7 (20.6%) patients. Among 34 patients with anemia, patients with ACD - 15 (44.1%) predominated. In the second place, 10 (29.4%) showed a combination of ACD with functional deficiency of iron, and 8 (23.5%) patients had signs of IDA. Only one of the subjects had signs of scarce anemia. Consequently, anemic syndrome in patients with AS is represented by ACD, ACD with iron deficiency and the actual IDA.

The analysis did not reveal significant differences in hemoglobin levels in the groups of patients with different types of anemia, depending on gender, age and duration of the disease.

The patients with different types of anemic syndrome did not have significant differences in haemoglobin content, the number of red blood cells and the magnitude of the MCH, but significantly differed in magnitude MCV. The lowest values of MCV (73.5 ± 3.14 ft) were in patients with IDA, intermediate (86.22 ± 2.6 ft) in the group of patients with ACD with functional deficiency of iron and the highest (94.2 ± 1.68 flask) among people with ACD (p <0.05). According to cytometric distribution, ACD was mostly (80%) normocytic, 13.3% macrocytic and only 6.65% microcytic. ACD with functional deficiency of iron was normocytic in 70% of cases, in 20% and 10% of cases, microcytic and macrocytic, respectively. Microcytic changes of erythrocytes most often in 75% were registered in the group of patients with IDA.

The course of the AS was accompanied by significant violations of iron exchange. In particular, with anemia of the first degree, iron levels were 10.25 ± 0.26 mmol/l, and with anemia of the second degree 9.30 ± 0.63 mmol/l (p <0.05). With regard to the types of anemic syndrome, in patients with IDA, serum iron levels were 8.30 ± 0.21 mmol/l, or it was probably (38%) lower than in patients with ”pure” ACD. It was at the IDA that the total iron binding capacity (TIBC) was the highest. Patients with a combination of ACD with functional deficiency of iron with this indicator occupied an intermediate position between patients with IDA and ACD.

Conclusion: Thus, the most widespread variants of anemia in patients with AS are ACD, IDA and ACD with iron deficiency. ACD is in most cases a normocytic anemia, IDA - microcytic anemia, and ACD with iron deficiency mostly normocytic as well.

Disclosure of Interests: None declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.