Yu Caberry W, Waisberg Ethan, Kwok Jason M, Micieli Jonathan A
Department of Surgery (CWY), McMaster University, Hamilton, Canada ; UCD School of Medicine (EWH), University College Dublin, Belfield, Dublin, Ireland ; Department of Ophthalmology and Vision Sciences (JMK, JAM), Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Canada.
J Neuroophthalmol. 2022 Mar 1;42(1):e78-e86. doi: 10.1097/WNO.0000000000001408. Epub 2021 Oct 29.
Idiopathic intracranial hypertension (IIH) is a condition typically affecting young, obese women. Although anemia is recognized as a risk factor of IIH from case reports, their relationship remains controversial as several comparative studies showed no significant association. This study aimed to examine the relationship between anemia and IIH.
MEDLINE, Embase, Cochrane Library, and grey literature were searched to September 2020. Primary studies on patients with diagnoses of anemia of any kind and IIH were included. Primary outcomes included the total number of cases of anemia and IIH. A meta-analysis on the prevalence of anemia in IIH compared with control patients was conducted. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to rate the quality of evidence.
Overall, 62 cases and 5 observational or case-control studies were included. Pooled incidence of anemia in patients with IIH was 195/1,073 (18.2%). Patients with IIH (n = 774) had a significantly higher prevalence of anemia compared with controls (n = 230,981) (RR 1.44 [95% confidence interval 1.08-1.92]). Patients were 67.7% females and had a mean age of 22.4 years. The mean opening pressure was 37.9 cmH2O. Anemia was most commonly caused by iron deficiency (51.6%) and aplastic anemia (19.4%). Most patients (59.7%) showed improvement or resolution with anemia treatment only without intracranial pressure-lowering therapy. Evidence was limited because of high risk of reporting bias from the large number of case reports and case-control studies.
Anemia is significantly more common in IIH compared with control patients, and case reports suggest a direct relationship. Complete blood counts should be considered in all patients with papilledema, particularly in atypical presentations (male, nonobese, nonperipapillary retinal hemorrhages, prominent risk factor for anemia) or in treatment-refractory IIH.
特发性颅内高压（IIH）是一种典型影响年轻肥胖女性的疾病。尽管从病例报告中可知贫血是IIH的一个危险因素，但由于一些比较研究未显示出显著关联，它们之间的关系仍存在争议。本研究旨在探讨贫血与IIH之间的关系。
检索截至2020年9月的MEDLINE、Embase、Cochrane图书馆和灰色文献。纳入对任何类型贫血和IIH患者的原发性研究。主要结局包括贫血和IIH的病例总数。对IIH患者与对照患者的贫血患病率进行荟萃分析。采用推荐分级、评估、制定与评价（GRADE）对证据质量进行评级。
总体而言，纳入了62例病例以及5项观察性或病例对照研究。IIH患者中贫血的合并发生率为195/1073（18.2%）。与对照组（n = 230,981）相比，IIH患者（n = 774）的贫血患病率显著更高（RR 1.44 [95%置信区间1.08 - 1.92]）。患者中67.7%为女性，平均年龄为22.4岁。平均初压为37.9 cmH₂O。贫血最常见的原因是缺铁（51.6%）和再生障碍性贫血（19.4%）。大多数患者（59.7%）仅通过贫血治疗而未进行降颅内压治疗即显示病情改善或缓解。由于大量病例报告和病例对照研究存在报告偏倚的高风险，证据有限。
与对照患者相比，贫血在IIH中明显更为常见，病例报告提示两者存在直接关系。所有视乳头水肿患者均应考虑进行全血细胞计数，尤其是在非典型表现（男性、非肥胖、非视乳头周围视网膜出血、存在明显贫血危险因素）或难治性IIH患者中。
