Variation in the incidence of hospital-acquired anemia during hospitalization with acute myocardial infarction (data from 57 US hospitals)

Incidence of hospital-acquired anemia in hospitalized dogs and cats

OBJECTIVE To determine the incidence of hospital-acquired anemia among dogs and cats hospitalized at a private emergency and referral center and identify possible risk factors. DESIGN Prospective, observational study. ANIMALS 56 patients (46 dogs and 10 cats). PROCEDURES Patients admitted from August 2014 through March 2015 and hospitalized for ≥ 48 hours were eligible for inclusion. Hospital-acquired anemia was defined as a PCV within reference limits on admission with development of anemia during hospitalization. Packed cell volume was measured once every 24 hours, and IV fluid volumes and blood volumes removed by means of phlebotomy were recorded. RESULTS The incidence of hospital-acquired anemia for dogs and cats combined was 34% (19/56) by 24 hours, 43% (24/56) by 48 hours, and 48% (27/56) by 72 hours. The incidence of hospital-acquired anemia was 70% (7/10) in cats and 43% (20/46) in dogs. Patients that underwent surgery had an increased odds of developing hospital-acquired anemia, compared with patients that did not undergo surgery (OR, 9.79; 95% confidence interval, 1.92 to 50.0). Cumulative phlebotomy volumes > 3% of total estimated blood volume significantly increased the risk of developing hospital-acquired anemia. CONCLUSIONS AND CLINICAL RELEVANCE Cumulative phlebotomy volumes > 3% of total blood volume and undergoing surgery significantly increased the risk that dogs and cats would develop hospital-acquired anemia. Further investigation is warranted for early identification of small animal patients at risk for development of hospital-acquired anemia and to inform effective treatment strategies.

Anemia and Red Blood Cell Transfusion: Advances in Critical Care

Anemia is common in the intensive care unit (ICU), resulting in frequent administration of red blood cell (RBC) transfusions. Significant advances have been made in understanding the pathophysiology of anemia in the ICU, which is anemia of inflammation. This anemia is related to high hepcidin concentrations resulting in iron-restricted erythropoiesis, and decreased erythropoietin concentrations. A new hormone (erythroferrone) has been identified, which mediates hepcidin suppression to allow increased iron absorption and mobilization from iron stores. RBC transfusions are most commonly administered to ICU patients for treatment of anemia. All strategies to reduce anemia in the ICU should be implemented.

Anemia in Intensive Cardiac Care Unit patients - An underestimated problem

The heterogeneous group of patients admitted to Intensive Cardiac Care Unit (ICCU) as well as nonspecific complaints associated with anemia might be the reason for underdiagnosing or minimization of this problem. Because of this heterogeneity, there are no clear guidelines to follow. It is known that anemia is impairing the outcome. Thus, it is crucial to keep alert in the diagnosis and treatment of anemia, especially in critically ill cardiac patients. The greatest groups of patients admitted to ICCU are those with acute coronary syndromes (ACS), acute decompensated heart failure (ADHF), severe arrhythmias as well as individuals after cardiac operations. However, patients suffering other critical cardiac illnesses quite often become anemic during hospitalization in ICCU. It is because anemia is typed in the clinical features of heavy diseases or may be the consequence of treatment. The current review focuses on the incidence, complex etiology and predictive role of anemia in a diverse group of ICCU patients. It discusses clinical aspects of anemia treatment in particular groups of critically ill cardiac patients because proper treatment increases chances for recovery and improves the outcome in this severe group of patients.

Is anemia a new cardiovascular risk factor?

Anemia is frequent in patients with cardiovascular disease and is often characterized as the fifth cardiovascular risk factor. It is considered to develop due to a complex interaction of iron deficiency, cytokine production and impaired renal function, although other factors, such as blood loss, may also contribute. Unfortunately, treatment of anemia in cardiovascular disease lacks clear targets and specific therapy is not defined. Treatment with erythropoietin-stimulating agents in combination with iron is the basic strategy but clear guidelines are not currently available. This review aims to clarify poorly investigated and defined issues concerning the relation of anemia and cardiovascular risk--in particular in patients with acute coronary syndromes and chronic heart failure--as well as the current therapeutic strategies in these clinical conditions.

A retrospective study investigating the incidence and predisposing factors of hospital-acquired anemia

Hospitalized patients frequently have considerable volumes of blood removed for diagnostic testing which could lead to the development of hospital-acquired anemia. Low hemoglobin levels during hospitalization may result in significant morbidity for patients with underlying cardiorespiratory and other illnesses. We performed a retrospective study and data was collected using a chart review facilitated through an electronic medical record. A total of 479 patients who were not anemic during admission were included in analysis. In our study, we investigated the incidence of HAA and found that, between admission and discharge, 65% of patients dropped their hemoglobin by 1.0 g/dL or more, and 49% of patients developed anemia. We also found that the decrease in hemoglobin between admission and discharge did not differ significantly with smaller phlebotomy tubes. In multivariate analysis, we found that patients with longer hospitalization and those with lower BMI are at higher risk of developing HAA. In conclusion, our study confirms that hospital-acquired anemia is common. More aggressive strategies such as reducing the frequency of blood draws and expanding the use of smaller volume tubes for other laboratory panels may be helpful in reducing the incidence of HAA during hospitalization.