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P121 Haemorrhage adjusted iron-requirements and exercise capacity in hereditary haemorrhagic telangiectasia patients

Introduction and objectives Anaemia is a common cause of reduced exercise capacity, including in patients with pulmonary arteriovenous malformations (AVMs), most of whom have hereditary haemorrhagic telangiectasia (HHT). In HHT, low haemoglobin is often attributed to gastrointestinal bleeding. Additionally, more than 90% of HHT patients experience nosebleeds (epistaxis) that can lead to substantial but overlooked blood losses. The goal of this study was to test if greater iron losses, specifically due to HHT nosebleeds was associated with reduced exercise capacity. Methods Between May 2017 and May 2019, 130 patients with a clinical and/or molecular diagnosis of HHT completed the Veterans Specific Activities Questionnaire (VSAQ) when attending their clinical review. This validated, self-reported patient questionnaire was used to determine exercise capacity by calculating the predicted metabolic equivalents (METs). Nosebleed severity was quantified by frequency, duration and intensity. Iron intake (dietary, tablet and intravenous), blood transfusions, and other treatments and physiological variables were also recorded. The severity of nosebleeds was used in addition to iron reference nutrient intake (RNI) to calculate haemorrhage adjusted iron requirements (HAIR). Relationships with METS were evaluated by multivariate linear regression. Results All 130 patients in the study had epistaxis, with some having up to 300 nosebleeds per month, lasting up to 150 minutes each. The median HAIR was 30.8 mgs of iron per day (range 8.7–4075 mg/day), compared to RNIs of 14.8 mg/day for premenopausal females and 8.7 mg/day for males/postmenopausal females. In crude regression analyses, patients with higher HAIR (i.e. higher iron requirements due to nosebleeds) had reduced exercise capacity (METS, p=0.0021). Surprisingly, in crude and HAIR-adjusted regression there was no association between exercise capacity (METS) and use of iron tablets, intravenous iron or blood transfusions. However, using clinical notes descriptor, higher dietary iron intake was associated with greater exercise capacity/METS (p=0.028). Conclusion HAIR is more discriminatory in identifying HHT patients ‘at risk’ of iron deficiency than iron RNI. Nosebleeds are associated with reduced exercise capacity, highlighting the need for concurrent investigation of nosebleeds alongside gastrointestinal bleeds in HHT/pulmonary AVM patients with iron-deficiency and/or anaemia. Replicate studies are recommended to confirm these associations.