To understand the hemoglobin (Hb) thresholds US Intensivists (ICUMDs) use to assess and manage anemia in critically ill COPD patients (ICU-COPD).
A survey was conducted to identify Hb thresholds representing presence and severity of anemia in ICU-COPD.
Ninety-nine ICUMDs, who care almost exclusively for adult patients, completed the survey at a specialty society meeting in 2005. All were either certified or eligible in Critical Care, with the specialty of Pulmonology in 31%, Internal Medicine 45%, Surgery/Trauma 20%, Anesthesia 18%, and other 8%. 30% have been in practice for <5 years, with 41% and 29% in practice for 5-15 years and >15 years, respectively. 48% work in a university-affiliated hospital, and 42% and 34% are affiliated with hospitals with >500 total and >50 ICU beds, respectively. Over 70% of responders see >80% of their patients in a hospital setting, and >1/3 spend >80% of their time in the ICU. Of the mean 36±27 ICU pts seen/week, on the average 13±14 (36%) are estimated to have COPD, with 9±9 (69%) on mechanical ventilation (MV). Over 2/3 of the responders didn’t consider even mild anemia to be present above an Hb threshold of 10g/dL, and nearly 3/4 deemed severe anemia to be present only at Hb≤7g/dL. Despite this, over 50% utilize Hb≥8g/dL as a transfusion threshold for ICU-COPD, regardless of their MV status. Interestingly, 58% and 59% of the responders identified Hb≥10g/dL as the optimal Hb level in these patients off and on MV, respectively.
Despite the accepted WHO definition of anemia (men, Hb<13g/dL; women, Hb<12g/dL), the majority of ICUMDs surveyed do not consider anemia to be present in ICU-COPD until the Hb is ≤10g/dL, and consider severe anemia to be present only at Hb≤7g/dL.
Consistent with the findings of the recent Canadian survey by Hebert et al (Crit Care Med 2005), in the US much like in Canada, utilization of 7g/dL as the transfusion threshold (Hebert et al, NEJM 1999) is far from ubiquitous.
Marya Zilberberg, Employee Marya Zilberberg, MD is an employee of Ortho Biotech Clinical Affairs, LLC. Michele Pisano, PharmD, is an employee of Ortho Biotech Products, LP.