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Anemia of inflammation associated with periodontitis: Analysis of two clinical studies

Research output: Contribution to journalArticlepeer-review

Luigi Nibali, Ulpee Darbar, Thanasak Rakmanee, Nikos Donos

Original languageEnglish
Pages (from-to)1252-1259
Number of pages8
JournalJournal of Periodontology
Issue number11
Early online date6 Jun 2019
Accepted/In press23 May 2019
E-pub ahead of print6 Jun 2019
Published11 Nov 2019


King's Authors


BACKGROUND: While leukocytosis is a common feature of severe periodontitis, a smaller amount of evidence has been produced on erythrocytes counts in periodontitis, suggesting a possible tendency to anemia. The aim of this study was to investigate the associations between periodontitis and circulating leukocytes, erythrocytes, and platelets. 

METHODS: The study included 471 patients with periodontitis (including aggressive periodontitis [AgP], and chronic periodontitis [CP]) and periodontal health. A separate sample of 333 patients from a previous study (127 AgP and 206 periodontally healthy) was used as replication. Periodontal clinical data were collected and a blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes and platelets. 

RESULTS: Adjusted linear regression analyses revealed associations between periodontitis and total leukocytes counts (p < 0.001), neutrophil counts (P <0.001) and hematocrit (HCT) levels (P = 0.045). Sub-analysis revealed no statistically significant differences between AgP and CP. Disease severity was correlated with total leukocyte and neutrophil counts and HCT (P <0.001, P <0.001 and P = 0.004, respectively). In the replication sample, adjusted linear regression analysis revealed associations between periodontitis and decreased hemoglobin (HB) (P = 0.009), mean corpuscular hemoglobin (MCH) (P = 0.023), and MCH concentration (P <0.001). A subset of patients included in these studies (14% to 15.7% of periodontitis versus 8.4% to 10.2% of healthy, respectively, in the two cohorts) were anemic based on the World Health Organization criteria. 

CONCLUSION: This paper, reporting results of periodontal examination and blood sampling in over 800 patients, suggest that not just leukocytosis but also tendency to "anemia of inflammation" are typical features of periodontitis.

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