Iron Deficiency in COPD

How Common is Iron Deficiency in COPD? In a recent article published online in the British Medical Journal Open, Nickol and colleagues from Oxford University Hospital in the United Kingdom compared iron deficiency in 113 patients with COPD and 57 healthy individuals. Low iron was defined by a low value for one of more of 3 specific blood tests. Overall, the deficiency was more common in COPD (18%) than healthy controls (5%). Interestingly, the hemoglobin level (number of red blood cells) was similar between the two groups. This means that in general those with COPD did NOT have anemia (low red blood cells) despite low levels in their blood. Iron deficiency was associated with lower oxygen saturation levels and higher levels of C-reactive protein (CRP), a marker of inflammation in the body. The authors concluded that iron deficiency: 1) is common in COPD; 2) may occur without anemia; 3) appears related to inflammation; and 4) is associated with lower oxygen levels and an increase in self-reported worsening of breathing symptoms My comment: Human cells require iron to provide energy. More than one-half of our iron is contained in hemoglobin within red bloods cells – and is used to carry oxygen to all parts of our body. It is also found in bone marrow (where red blood cells are made), liver, and spleen. Reserves are mainly found in the liver.  
Iron is part of hemoglobin found in red blood cells which carry oxygen to all parts of our body

Iron is part of hemoglobin found in red blood cells which carry oxygen to all parts of our body

              Bacterial must also have iron in order to survive. If you have a bacterial infection, the bacteria try to take iron from cells. However, our immune system fights back and tries to withhold iron from the bacteria. If you have a chronic or persistent bacterial infection, this struggle for iron can persist and result in low iron levels  and may even cause anemia (low number of red blood cells). Our intestines absorb iron from food. The best absorbed forms come from red meat, whereas certain plants, such as spinach, also contain iron. Some vitamins and supplements can also be a source of iron. We all experience a small,  but steady loss of iron due to blood loss in our intestines, by sweating, and by shedding cells of our skin and the lining of our intestinal tract. Too much iron can be toxic. Excess amounts can cause a liver condition called hemochromatosis. What should you do? If you feeling fine, do nothing. However, if you have a persistent bacterial infection, OR if you feel tired all of the time, OR if you believe that the foods that you eat do not contain much iron, then you should mention this to your doctor.  He/she may decide to order a blood test to measure your iron and red blood cell levels.      

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.