Study of Iron Profile and Vitamin B12 in Patients with Heart Failure with Reduced Ejection Fraction

Iron Deficiency and Vitamin B12 deficiency are one of the commonest nutritional deficiencies worldwide, affecting large numbers of the population being more common in resource limited country like Nepal. It is of global concern that there might be association of these deficiencies with or without anemia with heart failure. This study accessed the Iron profile and Vitamin B12 level in patients with HFrEF admitted in Manipal Teaching Hospital. Serum Iron, Ferritin, and Transferrin Saturation was calculated and the prevalence of iron deficient and Vitamin B12 deficient cases with HFrEF was studied. It was a hospital based observational cross-sectional study, a total of N=57 patients who had a diagnosis of heart failure with reduced ejection fraction based on the Framingham Criteria and Echocardiography meeting all the inclusion and exclusion criteria were included. They underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin saturation percentage, serum ferritin, total iron binding capacity. Iron deficiency was defined as Serum ferritin <100 μg/l or Serum ferritin level of 100– 300 μg/l and a transferrin saturation of <20 %. Vitamin B12 deficiency was defined as level <239pg/ml. Anemic females were more than anemic males (55.9% vs 44.1%) and it was statistically significant. (p< 0.01) The prevalence of anemia was increasing with the age, highest being over 70 years of age. Iron deficient cases with anemia were 66.7%. Three fourth (75.4%) cases had transferrin saturation less than 20%. Vitamin B12 deficiency was prevalent in one fourth (28%) of cases with female preponderance and was found statistically significant (p= 0.02). Iron deficiency was prevalent in patients with heart failure and reduced ejection fraction irrespective of anemia and hemoglobin levels. In female gender, the association of HFrEF with anemia was statistically significant. Contrary to our expectation, Vitamin B12 deficiency prevalence was relatively low in our study and statistically significant association was seen in female population. Measurement of iron status could be considered during workup of heart failure patients.