HEMATOPOIETIK KÖK HÜCRE NAKLI OLAN HASTALARDA ANEMI VARLIĞININ FIZIKSEL FONKSIYONLAR ÜZERINE ETKISI VAR MIDIR?

Öz

Amaç: Anemi, hematolojik malignitesi olan hastalarda fiziksel fonksiyonları etkileyebilen bağımsız bir faktör olarak bulunmuştur. Çalışmamızda, hematopoietik kök hücre nakli (HKHN) ile tedavi edilen hastalarda aneminin fiziksel fonksiyonlar üzerine etkisinin belirlenmesi amaçlandı. Yöntem: HKHN ile tedavi edilen toplam 82 hasta retrospektif olarak analiz edildi. Anemi varlığı, WHO standardına göre belirlendi. Fiziksel değerlendirmeler; yorgunluk, el kavrama ve periferik kas kuvveti, fonksiyonel performans ve günlük yaşam aktivitelerini (GYA) içermekteydi. Kaydedilen değişkenler anemisi olan ve olmayan hastalar arasında karşılaştırıldı. Ek olarak, transplantasyon tipi ve HKHN'den bu yana geçen sürenin sonuçlarımız üzerindeki etkisi analiz edildi. Sonuçlar: Anemisi olan hastalarda kuadriseps femoris kas kuvveti, fonksiyonel performans ve GYA düzeyi anemisi olmayan hastalara göre anlamlı olarak daha düşüktü (sırasıyla p=0.025, p=0.001 ve p=0.009). Ek olarak, HKHN'den bu yana geçen süre her iki grupta kontrol edildiğinde, anemi olan ve olmayan hastalar arasında fonksiyonel performans ve GYA'da hala anlamlı fark vardı. Tartışma: HKHN ile tedavi edilen hastalarda anemi varlığının kas gücü, fonksiyonel performans ve GYA düzeyi üzerinde olumsuz pek çok etkileri vardır. Sağlık profesyonelleri, anemili hastaların fonksiyonel sorunları olabileceğinin farkında olmalıdır.

Anahtar Kelimeler

• Anemi
• Fonksiyonel performans
• Hematopoietik kök hücre nakli
• Fiziksel fonksiyon

Does the presence of anemia have an impact on physical functions in patients treated with hematopoietic stem cell transplantation?

Abstract

Purpose: Anemia has been found as an independent factor that may influence physical functions in patients with hematological malignancy. We aimed to determine impact of anemia on physical functions in patients treated with hematopoietic stem cell transplantation (HSCT). Methods: A total of 82 patients treated with HSCT were retrospectively analyzed. The presence of anemia was determined in accordance with the WHO standard. Physical examinations were included fatigue, hand grip and peripheral muscle strength, functional performance, and activities of daily living (ADL). We compared recorded variables between patients with and without anemia. Additionally, impact of transplantation type and duration since HSCT on our results were analyzed. Results: Patients with anemia had significantly poorer quadriceps femoris muscle strength, functional performance, and ADL level than patients without anemia (p=0.025, p=0.001, and p=0.009, respectively). Additionally, the duration since HSCT were adjusted in two groups, there was still significant difference in functional performance and ADL between patients with and without anemia (p˂0.05). Conclusion: The presence of anemia in patient treated with HSCT have negative impact on muscle strength, functional performance, and ADL level. Health care professionals should be aware that patients with anemia may have functional problems.

Keywords

• Anemia
• functional performance
• hematopoietic stem cell transplantation
• physical function

Kaynakça

1. Iida M, Liu K, Huang XJ, Huang H, Kuwatsuka Y, Moon JH, et al. Report on hematopoietic cell transplantations performed in 2018/2019 focusing on the trends of selection of stem cell sources in the Asia-Pacific region: APBMT Activity Survey. Blood Cell Ther. 2023 Oct 6;6:114-123.
2. Gifford G, Sim J, Horne A, Ma D. Health status, late effects and long-term survivorship of allogeneic bone marrow transplantation: a retrospective study. Intern Med J. 2014;44:139-47.
3. Majhail NS. Long-term complications after hematopoietic cell transplantation. Hematol Oncol Stem Cell Ther. 2017;10:220-7.
4. Kenar G, Köksoy EB, Ürün Y, Utkan G. Prevalence, etiology and risk factors of anemia in patients with newly diagnosed cancer. Support Care Cancer. 2020;28:5235-42.
5. Natalucci V, Virgili E, Calcagnoli F, Valli G, Agostini D, Zeppa SD, et al. Cancer Related Anemia: An Integrated Multitarget Approach and Lifestyle Interventions. Nutrients. 2021;13:482.
6. Ferretti G, Fagoni N, Taboni A, Vinetti G, di Prampero PE. A century of exercise physiology: key concepts on coupling respiratory oxygen flow to muscle energy demand during exercise. Eur J Appl Physiol. 2022;122:1317-65.
7. Owusu C, Cohen HJ, Feng T, Tew W, Mohile SG, Klepin HD, et al. Anemia and Functional Disability in Older Adults With Cancer. J Natl Compr Canc Netw. 2015;13:1233-9.
8. Gi YM, Jung B, Kim KW, Cho JH, Ha I-H. Low handgrip strength is closely associated with anemia among adults: A cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES). PLoS One. 2020;15:e0218058.

9. Liu Q, You J, Zhong M, Wu Z, Geng Y, Huang C. Hemoglobin level is negatively associated with sarcopenia and its components in Chinese aged 60 and above. Front Public Health. 2023;11:1081843.
10. Joosten E, Detroyer E, Milisen K. Effect of anaemia on hand grip strength, walking speed, functionality and 1 year mortality in older hospitalized patients. BMC Geriatr. 2016;16:153.
11. Lee BJ, Chi JH. Association between anemia and grip strength indices combined with anthropometry in the Korean population. Sci Rep. 2023;13:18517.
12. Fukushima T, Nakano J, Ishii S, Natsuzako A, Kawachi H, Sakamoto J, et al. Influence of hemoglobin level on muscle and physical functions, activities of daily living, and quality of life in patients with hematological malignancies. Integr Cancer Ther. 2019;18:1534735419842196.
13. Morishita S, Kaida K, Yamauchi S, Sota K, Ishii S, Ikegame K, et al. Relationship between corticosteroid dose and declines in physical function among allogeneic hematopoietic stem cell transplantation patients. Support Care Cancer. 2013;21:2161-9.
14. World Health Organization, 2011. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity.
15. Kim HJ, Abraham I. Measurement of fatigue: Comparison of the reliability and validity of single-item and short measures to a comprehensive measure. Int J Nurs Stud. 2017;65:35-43.
16. Balogun JA, Akomolafe CT, Amusa LO. Grip strength: effects of testing posture and elbow position. Arch Phys Med Rehabil. 1991;72:280-3.
17. Liu CJ, Marie D, Fredrick A, Bertram J, Utley K, Fess EE. Predicting hand function in older adults: evaluations of grip strength, arm curl strength, and manual dexterity. Aging Clin Exp Res. 2017;29:753-60.
18. Baschung Pfister P, de Bruin ED, Sterkele I, Maurer B, de Bie RA, Knols RH. Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: An intra- and interrater reliability and validity study. PLoS One. 2018;13:e0194531.
19. Glenn JM, Gray M, Binns A. Relationship of Sit-to-Stand Lower-Body Power With Functional Fitness Measures Among Older Adults With and Without Sarcopenia. J Geriatr Phys Ther. 2017;40:42-50.
20. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61-5.
21. Küçükdeveci AA, Yavuzer G, Tennant A, Süldür N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med. 2000;32:87-92.
22. Cecchi F, Pancani S, Vannetti F, Boni R, Castagnoli C, Paperini A, et al. Hemoglobin concentration is associated with self-reported disability and reduced physical performance in a community dwelling population of nonagenarians: the Mugello Study. Intern Emerg Med. 2017;12:1167-1173.
23. Tseng SH, Lee WJ, Peng LN, Lin MH, Chen LK. Associations between hemoglobin levels and sarcopenia and its components: Results from the I-Lan longitudinal study. Exp Gerontol. 2021;150:111379.
24. Wakasugi T, Morishita S, Kaida K, Iida M, Lu DP, Tong W, et al. Impaired skeletal muscle oxygenation following allogeneic hematopoietic stem cell transplantation is associated with exercise capacity. Support Care Cancer. 2018;26:2149-60.
25. Barği G, Boşnak Güçlü M, Türköz Sucak G. How Does Myeloid or Lymphoid Origin of Hematologic Malignancy Affect Pulmonary Function, Muscle Strength, Exercise Capacity, and Quality of Life? Turk J Physiother Rehabil. 2020; 31(2):115-122.
26. Corona LP, Andrade FCD, da Silva Alexandre T, de Brito TRP, Nunes DP, de Oliveira Duarte YA. Higher hemoglobin levels are associated with better physical performance among older adults without anemia: a longitudinal analysis. BMC Geriatr. 2022;22:233.
27. Brożonowicz J, Ćwirlej-Sozańska A, Sozański B, Orzech-Janusz E, Garus A, Grzesik M, et al. Relationship between Selected Functional Performance Parameters and the Occurrence of Anaemia in Hospitalized Females and Males Aged 80 and More. Int J Environ Res Public Health. 2022;19:13179.
28. Bohannon RW. Considerations and practical options for measuring muscle strength: a narrative review. BioMed Res Int. 2019; 8194537.
29. Hirani V, Naganathan V, Blyth F, Couteur DGL, Seibel MJ, Waite LM, et al. Low hemoglobin concentrations are associated with sarcopenia, physical performance, and disability in older australian men in cross-sectional and longitudinal analysis: the concord health and ageing in men project. J Gerontol A Biol Sci Med Sci. 2016;71:1667-75.
30. Wang J, Wang C, Li X, Guo J, Dove A, Cui Z, et al. Association of Anemia with Cognitive Function and Dementia Among Older Adults: The Role of Inflammation. J Alzheimers Dis. 2023;96:125-134.