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.
Plasma cell myeloma (PCM) is a lymphoproliferative disorder characterized by the malignant growth of monoclonal plasma cells within the bone marrow. Although risk factors for the development of PCM have been identified, the etiology on the majority of patients with PCM remains unclear. Cigarette smoking has been postulated as a potential risk factor for lymphoid malignancies; however, the association with PCM is inconclusive. We have carried out a meta-analysis of observational studies to assess the relationship, if any, between cigarette smoking and PCM. A literature search through December 2011 rendered 4 prospective cohort and 13 case-control studies evaluating such association. Our categorical meta-analysis showed that there is no association between ever, current, and former smokers and PCM. This lack of association was maintained when analyzing by study design, study quality, and geographical area of report. Similarly, metaregression analysis showed no association with the number of cigarettes smoked per day. In conclusion, our meta-analysis shows that there is no relationship between cigarette smoking and an increased incidence of PCM. Future studies should focus on other potential risk factors for PCM.PCM is a lymphoproliferative disorder characterized by the malignant accumulation of monoclonal plasma cells within the bone marrow. Patients with PCM can present with anemia, renal dysfunction, hypercalcemia, and bony lytic lesions, and can develop disabling effects from this disease, such as bone fractures or permanent renal insufficiency. In the United States (US) alone, it has been estimated that 21,700 individuals will be diagnosed and 10,710 will die from PCM in 2012 [1]. Despite recent advances in the therapy of PCM (i.e., immunomodulators and proteasome inhibitors), PCM is considered incurable and the majority of patients will ultimately die from PCM-related complications. The etiology of PCM has been an area of active research and few risk factors have been described, such as older age, male sex, African descent, a positive family history, and increased body mass index [2]. However, the large majority of patients diagnosed with PCM do not have an identifiable risk factor. Cigarette smoking has been associated with an increased risk of developing lymphoproliferative disorders [3,4]. The purpose of our study was to evaluate the potential association that cigarette smoking could have on the incidence of PCM by performing a meta-analysis of observational studies.Our literature search through December 2011 rendered 161 returns, from which 133 were excluded because they were case reports, reviews, or did not pertain to our study. The reference list of the remaining 28 studies provided 7 additional studies for a total of 35. From these, 18 were excluded because they did not provide enough data to calculate the outcome, were already included in other studies, or did not focus on PCM or smoking. From these 17 studies, 4 were prospective cohort [5-8] and 13 were case-control studies [9][10][11][12][13][14][1...
Introduction While in the hospital, patients frequently have considerable volumes of blood removed for diagnostic testing which may contribute to the development of anemia associated with hospitalization. Our primary goal was to investigate the incidence of anemia acquired during hospitalization. As a secondary goal we evaluated the impact of using a smaller volume phlebotomy tube for the basic metabolic panel (BMP) on the incidence of hospital acquired anemia. Methods A retrospective study was conducted using patients admitted to an academic community teaching hospital in Providence, RI. Inclusion criteria included adult patients aged >18 years who were admitted to internal medicine inpatient service. Those patients who had acute medical conditions that may cause or contribute to the decrease in hemoglobin, such as gastrointestinal bleeding, transfusion dependent anemia, a previous history of anemia, hemolysis, hemorrhagic stroke, retroperitoneal bleed, chronic kidney disease/dialysis, or any hematologic malignancies or were on therapy that may affect hemoglobin levels such as iron or erythropoietin or chemotherapy were excluded. Patients who had central or peripherally central line, who received blood transfusion during hospitalization, who were hospitalized for less than 2 days, or were triaged to surgical, Intensive Care Unit, Cardiac Care Unit, maximum-care service, were also excluded. The volume of phelobotomy tube used for BMP was reduced by approximately 4mL. Eleven percent of blood draws in this hospital included BMP. To calculate the incidence of hospital acquired anemia, hemoglobin levels on admission were compared with those at discharge. The effect of the smaller volume BMP tubes on hospital acquired anemia was evaluated by comparing the incidence a of hospital acquired anemia before and after the change to a smaller volume was implemented. Results A total of 4206 hospitalizations were reviewed and 623 hospitalizations were included in our analysis. Between admission and discharge, 60% of patients dropped their hemoglobin by 1.0 g/dL or more; 56% of the men and 63% of the women. Upon discharge, 43% of the female patients and 46% of male patients who were not anemic at the time of admission had hemoglobin that had dropped into the anemic range. On average, men and women dropped their Hb by 1.3 g/dL. We also found that 61% of patients aged >65 years became anemic during hospitalization compared to 41% of patients aged ≤65 years (p<0.04). Patients with a high BMI had a smaller drop in hemoglobin on average than patients with a low BMI (p=0.01). When stratified by age, the implementation of a decrease in test tube size did not effect the decrease in hemoglobin. Conclusions Hospital acquired anemia has a high incidence and is more common in patients aged older than 65 years and has a lower frequency of occurrence in those with a higher BMI. Switching to a smaller volume BMP collecting tube did not significantly reduce the drop of hemoglobin between admission and discharge. Disclosures: No relevant conflicts of interest to declare.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.