AnemiaVitamin D levels

Several papers reported increased risk of anemia for those with lower serum 25-hydroxyvitmin D [25(OH)D] levels.

A study in Australia on those with noncholestatic chronic liver disease (CLD) found serum 25(OH)D levels of less than 25 nmol/L predicted coagulopathy, hyperbilirubinemia, hypoalbuminemia, increased alkaline phosphatase, and anemia and thrombocytopenia. Vitamin D inadequacy is common in noncholestatic CLD and correlates with disease severity, but secondary hyperparathyroidism is relatively infrequent. Management of CLD should include assessment of vitamin D status in all patients and replacement when necessary1.

A study of pregnant women in Tanzania with low serum 25(OH)D levels had a 46% higher risk of developing anemia than those with adequate serum 25(OH)D levels2.

In a study of chronic kidney disease patients in the United States, 41% had anemia. Both 25(OH)D and 1,25-dihydroxyvitmin D [1,25(OH)2D] levels were associated with decreased hemoglobin levels and anemia in this study3.

A study in Los Angeles found vitamin D deficiency correlated with presence of anemia: Vitamin D has been suggested to have an effect on erythropoiesis. We sought to evaluate the prevalence of anemia in a population of individuals with vitamin D deficiency compared with those with normal levels in a population of a large integrated healthplan. A cross-sectional analysis in the period 1 January 2004 through 31 December 2006 of subjects with documented concurrent levels of 25-hydroxyvitamin D and hemoglobin were evaluated. Vitamin D deficiency was defined as <30 ng/mL and anemia was defined as a hemoglobin <11 g/dL. A total of 554 subjects were included in the analysis. Anemia was present in 49% of 25-hydroxyvitamin D-deficient subjects compared with 36% with normal 25-hydroxyvitamin D levels (p < 0.01). Odds ratio for anemia in subjects with 25-hydroxyvitamin D deficiency using logistic regressions and controlling for age, gender, and chronic kidney disease was 1.9 (95% CI 1.3-2.7). 25-hydroxyvitamin D-deficient subjects had a lower mean Hb (11.0 vs. 11.7; p = 0.12 ) and a higher prevalence of erythrocyte stimulating agent use (47% vs. 24%; p < 0.05). This study demonstrates an association of vitamin D deficiency and a greater risk of anemia, lower mean hemoglobin, and higher usage of erythrocyte-stimulating agents. Future randomized studies are warranted to examine whether vitamin D directly affects erythropoiesis4.

In a cross-sectional study in the United States, “Vitamin D deficiency was associated with anemia prevalence independent of age, sex, or race/ethnicity (OR 1.47, 95% CI 1.06; 2.05, p=0.02) and varied significantly by anemia subtype (p overall =0.003). The prevalence of vitamin D deficiency was 33.3% in the non-anemic population, 56% in anemia of inflammation (AI) (p=0.008), and 33.0% in unexplained anemia (p=0.55). Non-Hispanic blacks had a 7-fold increased risk of AI compared with whites, and this was partially attenuated after adjusting for vitamin D deficiency5.”

Thus, there is good evidence that lower vitamin D levels are associated with increased risk for anemia.

Athletes often have low serum 25(OH)D levels6, and better athletic performance has been linked to higher serum 25(OH)D levels7. Reduced red blood cell levels may be one reason for this effect.

Page last edited: 08 May 2011

References

  1. Fisher, L. Fisher, A. Vitamin D and parathyroid hormone in outpatients with noncholestatic chronic liver disease. Clin Gastroenterol Hepatol. 2007 Apr; 5 (4): 513-20.
  2. Mehta, S. Giovannucci, E. Mugusi, F. M. Spiegelman, D. Aboud, S. Hertzmark, E. Msamanga, G. I. Hunter, D. Fawzi, W. W. Vitamin D status of HIV-infected women and its association with HIV disease progression, anemia, and mortality. PLoS One. 2010; 5 (1): e8770.
  3. Patel, N. M. Gutierrez, O. M. Andress, D. L. Coyne, D. W. Levin, A. Wolf, M. Vitamin D deficiency and anemia in early chronic kidney disease. Kidney Int. 2010 Apr; 77 (8): 715-20.
  4. Sim, J. J. Lac, P. T. Liu, I. L. Meguerditchian, S. O. Kumar, V. A. Kujubu, D. A. Rasgon, S. A. Vitamin D deficiency and anemia: a cross-sectional study. Ann Hematol. 2010 May; 89 (5): 447-52.
  5. Perlstein, T. S. Pande, R. Berliner, N. Vanasse, G. J. Prevalence of 25-hydroxyvitamin D deficiency in subgroups of elderly persons with anemia: association with anemia of inflammation. Blood. 2011 Jan 14;
  6. Constantini, N. W. Arieli, R. Chodick, G. Dubnov-Raz, G. High prevalence of vitamin D insufficiency in athletes and dancers. Clin J Sport Med. 2010 Sep; 20 (5): 368-71.
  7. Cannell, J. J. Hollis, B. W. Sorenson, M. B. Taft, T. N. Anderson, J. J. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009 May; 41 (5): 1102-10.