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Critical Care |

The Epidemiology of Hospital-Acquired Blood Loss in Acutely Ill Patients

William Marino*, MD; Joan Harigopalan, MD; Yuanbin Chen, MD; Anmar Sheet, MD
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Montefiore Medical Center, Mt. Kisco, NY


Chest. 2012;142(4_MeetingAbstracts):303A. doi:10.1378/chest.1383036
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Abstract

SESSION TYPE: Hematologic Problems in the ICU

PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM

PURPOSE: Hospital acquired anemia (HAA) is anemia which develops during hospitalization in the absence of pathologic bleeding. Like any other anemia it affects hospital morbidity and mortality and so should be addressed. Most studies of HAA have evaluated its relationship to diagnostic phlebotomy but factors other than phlebotomy probably influence its development as well. We have thus studied the effect of various disease states and physiologic parameters on its occurrence.

METHODS: Design: Retrospective collection of hematologic, blood chemistry and clinical data on all patients admitted to the medical service of this institution during a week’s time. Patients with active bleeding were excluded. The change in hematocrit during hospitalization was correlated with volume of phlebotomy, disease state, erythrocyte characteristics on admission and chemistry data.

RESULTS: 257 patients (100 male, 157 female; aged 62±18 years) were studied. There was a linear correlation between hematocrit decrease during hospitalization and phlebotomy volume, nutritional deficiencies (as suggested by RBC characteristics) and improved hydration as suggested by a decrease in BUN during hospitalization. There was no relationship between hematocrit decrease and age. The change in hematocrit per phlebotomy was highest for pneumonia, skin/soft tissue infections and CNS disease. The decrease in hematocrit per unit decrease in BUN was highest in cancer, pneumonia and skin/soft tissue infections. The decrease in hematocrit per day was highest in chest pain, and the decrease in hematocrit per admission was largest for cancer and skin/soft tissue infections.

CONCLUSIONS: HAA seems to be related not only to phlebotomy but also to disease state, hydration status and nutritional deficiencies affecting hematopoiesis . Phlebotomy seems to be most important in pneumonia, skin/soft tissue infections and CNS disease. Hydration is important in HAA associated with skin/soft tissue infections and cancer, but not in CNS disease. High volume phlebotomy early in admission is common in pneumonia and chest pain.

CLINICAL IMPLICATIONS: At the time of hospital admission factors such as iron and vitamin deficiency which could potentially limit patients' ability to respond to blood loss should be identified and corrected. Diagnostic phlebotomy during admissions for pneumonia, skin/soft tissue infections, CNS disease and chest pain should be scrutinized for opportunities to decrease its frequency and volume.

DISCLOSURE: The following authors have nothing to disclose: William Marino, Joan Harigopalan, Yuanbin Chen, Anmar Sheet

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Montefiore Medical Center, Mt. Kisco, NY

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