Increase in Hematocrit During Empagliflozin Treatment in a Diabetic Patient with Severe Anemia − A Case Study
In a case study involving a 78-year-old diabetic patient, where only the administration of empagliflozin led to the correction of severe anemia of unknown origin, Polish authors demonstrate the previously described pleiotropic effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i, i.e., gliflozins) on increasing hematocrit levels.
Case Description
A 78-year-old woman was admitted to the hospital for ST-segment elevation myocardial infarction (STEMI). Her medical history included diabetes mellitus, angioplasty of the right coronary artery, pacemaker implantation for third-degree atrioventricular block, paroxysmal atrial fibrillation on anticoagulation therapy, and hypothyroidism. Two years earlier, when she experienced non-ST-segment elevation myocardial infarction (NSTEMI), she was diagnosed with anemia. At that time, her anticoagulation therapy was changed from warfarin to rivaroxaban and subsequently dabigatran at a reduced dose, also due to decreased glomerular filtration.
In addition to confirming STEMI, further examinations revealed severe normocytic monochromic anemia. Despite extensive diagnostics, its cause could not be identified. The anemia exacerbated the patient's angina symptoms.
Due to the anemia, antiplatelet therapy with aspirin (ASA) and clopidogrel was discontinued, and apixaban was initiated at a dose of 2.5 mg twice a day. Other pharmacotherapy was optimized. The patient's new medications included levothyroxine (75 µg once daily), pantoprazole (20 mg once daily), torsemide (2.5 mg once daily), bisoprolol (2.5 mg once daily), telmisartan (40 mg once daily), eplerenone (25 mg once daily), rosuvastatin (20 mg once daily), trimetazidine (35 mg twice daily), and extended-release isosorbide mononitrate (25 mg once daily). Empagliflozin was added to the therapy at a dose of 10 mg once daily due to its demonstrated beneficial effects on the cardiovascular system.
For the previous two years, the anemia persisted despite initial oral iron supplementation, which was discontinued after four months due to side effects. Erythropoietic effects were noted only after the initiation of empagliflozin. After 1 and 2 months, increased levels of hemoglobin (from 61 to 107 and 121 g/l), hematocrit (from 30.0 to 32.2 and 36.6%), and erythrocyte count (from 2.98 to 3.40 and 3.76 × 1012/l) were observed.
Conclusion
The authors conclude that the increase in hematocrit in severe anemia may be related to the administration of empagliflozin. This is likely the first published case study showing the beneficial erythropoietic effect of this SGLT2 inhibitor.
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Source: Budzianowski J., Rzeźniczak J., Hiczkiewicz J. et al. Beneficial effects of empagliflozin on hematocrit levels in a patient with severe anemia. Daru 2021 Dec; 29 (2): 507−510, doi: 10.1007/s40199-021-00417-5.
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