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can't find klimas paper, can anyone help?


Senior Member
hi, i'm looking for a paper that links cfs to anemia of chronic disease. one of the co authors was Professor Nancy Klimas.. but she was not the lead author.

so far i have come up empty.. can anyone provide a link?



Senior Member
I was looking for a paper by Dr Klimas today as well - the one where she talks about how enforced rest gave the best outcomes for CFS/ME
Can't find that either.


Senior Member
hi, i'm looking for a paper that links cfs to anemia of chronic disease. one of the co authors was Professor Nancy Klimas.. but she was not the lead author.

so far i have come up empty.. can anyone provide a link?

I think this is the paper you have in mind. Anemia is spelt the British way in it, Anaemia.

Free full text: http://www.clinsci.org/cs/118/0125/cs1180125.htm

Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiacfunction.

Clin Sci (Lond). 2009 Oct 19;118(2):125-35.

Hurwitz BE, Coryell VT, Parker M, Martin P, Laperriere A, Klimas NG, Sfakianakis GN, Bilsker MS.

Behavioral Medicine Research Center, University of Miami, Miami, FL 33136, USA. bhurwitz@miami.edu


The study examined whether deficits in cardiac output and blood volume in a CFS (chronic fatigue syndrome) cohortwere present and linked to illness severity and sedentary lifestyle. Follow-up analyses assessed whether differencesin cardiac output levels between CFS and control groups were corrected by controlling for cardiac contractility andTBV (total blood volume). The 146 participants were subdivided into two CFS groups based on symptom severitydata, severe (n=30) and non-severe (n=26), and two healthy non-CFS control groups based on physical activity,sedentary (n=58) and non-sedentary (n=32). Controls were matched to CFS participants using age, gender, ethnicityand body mass. Echocardiographic measures indicated that the severe CFS participants had 10.2% lower cardiacvolume (i.e. stroke index and end-diastolic volume) and 25.1% lower contractility (velocity of circumferentialshortening corrected by heart rate) than the control groups. Dual tag blood volume assessments indicated that theCFS groups had lower TBV, PV (plasma volume) and RBCV (red blood cell volume) than control groups. Of the CFSsubjects with a TBV deficit (i.e. > or = 8% below ideal levels), the mean+/-S.D. percentage deficit in TBV, PV andRBCV were -15.4+/-4.0, -13.2+/-5.0 and -19.1+/-6.3% respectively. Lower cardiac volume levels in CFS weresubstantially corrected by controlling for prevailing TBV deficits, but were not affected by controlling for cardiaccontractility levels. Analyses indicated that the TBV deficit explained 91-94% of the group differences in cardiacvolume indices. Group differences in cardiac structure were offsetting and, hence, no differences emerged for leftventricular mass index. Therefore the findings indicate that lower cardiac volume levels, displayed primarily bysubjects with severe CFS, were not linked to diminished cardiac contractility levels, but were probably aconsequence of a co-morbid hypovolaemic condition. Further study is needed to address the extent to which thecardiac and blood volume alterations in CFS have physiological and clinical significance.

Sample quote

The CFS cohort in the present study
did not have blood chemistry abnormalities that would
warrant such a diagnosis. Thus the elevated prevalence
of low RBCV suggests that the CFS subjects may
have an anaemia type that goes undetected by standard
haematological evaluations. Normochromic normocytic
anaemia is one such condition that is defined by a
low RBCV, despite the presence of normal levels of
haematocrit, haemoglobin and serum ferritin, and red
blood cell count, size and shape [44]. This anaemia
type is common in chronic systemic disorders, such as
heart disease, renal failure, endocrine insufficiency,
hepatic disease, gastrointestinal malabsorption, rheumatological
conditions, chronic infections and cancer,
disorders that are exclusionary for a CFS diagnosis [20].
Thus CFS may be another chronic condition that results
in hypoproliferative anaemia. Current research suggests
that normochromic normocytic anaemia may arise from
a chronic inflammatory process that interferes with renal
erythropoietin production or signalling and by inhibiting
bone marrow red blood cell production [46]. Although a
chronic inflammatory condition accompanying CFS has
been hypothesized [47,48], such findings are inconsistent
and not yet confirmed [49].