A single‐centre review of iatrogenic anaemia in adult intensive care

Abstract

Objectives (a) To quantify the volume of diagnostic blood loss (DBL) and evaluate its impact on intensive care unit (ICU) patients, (b) examine the correlation between severity of disease and DBL and (c) identify potentially vulnerable patient subgroups. Background Iatrogenic anaemia is an important problem amongst ICU patients, with significant daily DBL. Methods A single‐centre observational cohort study was conducted at St George's Hospital, London, cardiac and general ICU. Forty patients were included in the study. Variables measured were volume of blood collected and discarded on a daily basis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, frequency of phlebotomy, haemoglobin concentration before and after admission to ICU, reason for admission and complications developed in ICU. Results Mean (SD) total volume drawn per patient per day over 4 days was 86.3 mL (19.58). Nearly 30% of the total blood taken was discarded. There was a strong positive correlation between patients admitted because of sepsis and volume of DBL (P < .01), APACHE II score and volume taken (P = .01), patients who developed respiratory failure requiring ventilation and volume taken (P < .01) and patients who had received a blood transfusion and volume taken (P < .01). Haemoglobin concentration on discharge was negatively associated with DBL volume (P < .01). Conclusion High volumes of blood were taken and discarded from the study population, possibly reflecting the fact that there are no guidelines for ICU staff in terms of the amount of blood that needs to be withdrawn in order to “prime” access lines.

Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss

“…The volume of blood typically needed for BGA is approximately 2 mL, for serum chemistries it is 7.5 mL, for citrate tubes it is 4.3 mL, for EDTA it is 2.7 mL, and it is up to 6 × 10-20 mL for blood cultures. A systematic review by Siegal et al pointed out that only 10% of collected 3: General ICU [1,9,10,46,49,50,60]; Medical ICU [27,29,47,48,51,54]; Medical/surgical ICU [11,56,57,62]; Surgical ICU [33,64]; other ICU [32,52,53,55,59,61,63,65].…”

“…The authors also revealed an independent correlation between the increased use of phlebotomy and the risk to develop hospital acquired anemia [29]. 3: General ICU [1,9,10,46,49,50,60]; Medical ICU [27,29,47,48,51,54]; Medical/surgical ICU [11,56,57,62]; Surgical ICU [33,64]; other ICU [32,52,53,55,59,61,63,65].…”

“…Koch et al showed that patients on cardiothoracic ICUs lose a median of 332 mL during their stay [28]. Furthermore, Holland et al showed high volumes of daily blood loss of 62 mL compared to non-cardiac surgery cohorts [49], suggesting that these cardiac patients are particularly at risk for the development of iatrogenic anemia. Vincent et al found in >1000 patients in Western European ICUs an average blood loss for diagnostics of up to 41.1 mL/d [52].…”

Proposta de um procedimento operacional padrão para a mitigação das reações transfusionais imediatas em um hospital universitário

“…São inúmeros os pacientes que se beneficiam da transfusão sanguínea, sendo com maior frequência de acordo com a literatura especializada os oncológicos, portadores de afecções hemorrágicas agudas, vítimas de trauma, Coagulação Intravascular Disseminada (CIVD), Púrpura Trombocitopenia Trombótica (PTT), tromocitopênicos e neutropênicos (Cabedal, 2019). Estima-se que paciente internados em Unidade de Terapia Intensiva (UTI) apesentem perda sanguínea de 86,3 ml em quatro dias resultando em anemia dilucional de origem iatrogênica que pode ser percebida com o confronto das variáveis do balanço hídrico e queda de hemoglobina em sete dias de internação (Holland, Peralta, Moss, Feane, & Uprichard, 2020;Witosz, Wojnarowicz, & Krzych, 2021).…”

Reducing Unnecessary Laboratory Utilization in the Medical ICU: A Fellow-Driven Quality Improvement Initiative

“…Proposed harms to the patient from excessive laboratory blood testing include injury during phlebotomy, anemia from repetitive phlebotomy, increased central catheter-access potentially leading to central catheter–associated bloodstream infections (CLABSIs), and unnecessary subsequent evaluations for out of range values ( 2 ). An observational study reported that patients were phlebotomized on average 86.3 mL of blood over the course of their first 4 days in the ICU and that nearly half of these patients then required a blood transfusion for anemia ( 3 ). Excessive laboratory utilization can also result in interpretative error and data overload for the physician ( 2 ).…”