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A new study found that one-third of intracerebral hemorrhage patients experience anemia and that this occurs due to continued inflammation, causing bone marrow erythropoiesis suppression. The study also demonstrated that IL-6 antagonists may benefit such patients, increasing erythropoiesis and reducing neural deficits.

Intracerebral hemorrhage (ICH) is among the leading causes of death and disability globally and occurs due to rupturing of one of the blood vessels supplying blood to the brain, leading to entry of blood into the brain parenchyma. The condition is life-threatening, with few treatment options. Even those who survive continue to experience many health issues affecting quality of life. Anemia is one of the common manifestations of ICH, yet its underlying mechanism remains unclear.

More Than One-Third Brain Hemorrhage Patients Experience Anemia 

In a new study, investigators found anemia in 39 patients out of 111 (35.1%) cases. They also found an association between anemia severity and higher scores on the National Institutes of Health Stroke Scale. This indicates that those with higher neurological deficits are also more likely to develop anemia. Further, it was seen that anemia was also associated with a worse prognosis. The findings of the study were shared at the 65th ASH Annual Meeting & Exposition.

Inflammation May Be an Underlying Cause of Erythropoiesis Suppression   

To understand how ICH affects bone marrow (BM) erythropoiesis, researchers carried out experiments on 12-month-old mice. The investigation found that ICH in mice caused an increase in monocyte progenitors but reduced myeloid progenitors and megakaryocyte erythrocyte progenitors compared to control mice. Further, it was noticed that there was reduced colony-forming ability of erythroid progenitors. 

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The researchers found that ICH caused a significant increase in inflammation and BM erythropoiesis suppression. Thus, the study hypothesized that inflammatory cytokines were responsible for erythropoiesis suppression. To test their hypothesis, they treated mice with experimental IL-6 antagonist MR16-1. This treatment resulted in an increase in erythropoiesis and increased peripheral red blood cells and hemoglobin levels. Additionally, MR16-1 treatment improved neurologic deficits and reduced brain hematoma.

The Bottom Line

Stroke is among the leading causes of mortality and disability. A significant number of stroke cases are due to ICH. ICH is quite challenging to treat, resulting in high mortality, and is associated with poor prognosis. Those diagnosed with the condition continue to experience severe neurological deficits along with many other symptoms. One such common issue affecting ICH patients is severe anemia. 

This new study indicates that anemia in ICH patients is a result of high blood levels of inflammatory markers or cytokines, especially IL-6. Further, the study found that IL-6 antagonists have a potential role in managing such patients by reducing anemia severity and helping reduce neurological deficits.


Zhang, S. (2023, December 11). Intracerebral hemorrhage leads to anemia by disrupting erythropoiesis and erythromyeloblastic islands. https://ash.confex.com/ash/2023/webprogram/Paper186235.html