Characterization and Prevalence of Anemia in Subjects with Spinal Cord Injury

INTRODUCTION: Anemia has been considered to be very prevalent in chronic diseases, commonly due to blood loss or inflammatory reasons; as so, it has been considered common sense to imply that anemia is also frequent among subjects with spinal cord injury. Likewise, malnutrition, reenforced by the common association between depression and spinal cord injury, justify the study of the prevalence of anemia in this population.

OBJECTIVE: To evaluate the prevalence of anemia among subjects with spinal cord injury, and its relation with the injury level and also if there is any difference when comparing patients from the Spinal Cord Injury Rehabilitation Ambulatory of UNICAMP (SCIRAU) and outpatients that weren’t previously followed by us, considered as controls; if anemia is found to be present, we intend to evaluate its etiology.

METHODOLOGY: Patients with spinal cord injury from SCIRAU and controls were randomly selected to be enrolled in this study, being 77,3% male (n=17) and 22,7% female (n=5). These patients were evaluated as of their level of injury (separated into paraplegic vs. tetraplegic) and age, being invited to offer a blood sample for analysis of hematological parameters; hemoglobin (Hb) and hematocrit were evaluated. To be considered as being anemic, the cutoff point was 12,0 g% for females and 13,0 g% for males.

RESULTS: The male group had a median age of 31.9 years, significantly lower then the female group, with a median of 46.4 years [p=0.02]. The median value of hemoglobin in the male group (M=14.72, SD=1.23) was statistically higher than the female group (M=12.78, SD=0.17) [p=0.00001]. Comparing the results of Hb between the paraplegic (M=14.48, SD=1.67, N=10) and tetraplegic (M=14.125, SD=1.10, N=12) patients, there were no statistically significant difference [p=0.56]. Such difference also was not confirmed when comparing SCIRAU patients (M=14.44, SD=1.43, N=18) and outpatients from the control group (M=13.58, SD=0.77, N=4) [p=0.16].

CONCLUSION: Surprisingly, none of the patients involved in this study had anemia. The difference between the hematological parameters when comparing male and female subjects was already expected and should not be attributed to the age difference. No significant relation between the level of injury and hemoglobin level were observed. As such, no difference could be seen among patients followed in our SCIRAU and control outpatients. Hence, even though spinal cord injury is considered to be a chronic disease and scientific literature suggest that these patients are at risk for malnutrition and depression (both associated with a higher prevalence of anemia), the hypothesis that these subjects present with a higher prevalence of anemia could not be seen in our study.