A number of studies have documented anemia associated with TB [18] [19] [20] . It is well established that erythropoiesis is suppressed by inflammatory mediators in anemia of chronic infection or inflammation and anemia caused by chronic infections including TB results from the effects of cytokines that mediate the inflammatory response,which may provides the development for ARDS [21] [22] [23] . As we know,the severity of anemia is mainly determined by hemoglobin level. The decrease in hemoglobin is assumed as a reflection of inflammation, which can explain the relationship between ARDS and hemoglobin in our study. This relationship is supported by our finding of hemoglobin being an independent predictor of ARDS development in miliary TB.