Iatrogenic anaemia and transfusion thresholds in ICU patients with COVID-19 disease at a tertiary care hospital

Beverina, Ivo; Borotto, Erika; Novelli, Chiara; Radrizzani, D.; Brando, Bruno

doi:10.1016/j.transci.2021.103068

Cited by 6 publications

(7 citation statements)

References 39 publications

(38 reference statements)

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“…However, hospitalization goes along with repeated blood sampling or occult gastro-intestinal bleeding, which may aggravate anemia especially when erythropoiesis is impaired. In a small cohort study involving 24 ICU patients with COVID-19 it was demonstrated that repeated routine blood sampling accounts for about one third of the total patients’ red blood cell mass decrease during ICU admission [ 35 ]. Moreover, in-hospital treatment can contain comprehensive infusion therapy, which has a diluting effect on hemoglobin levels, especially in the ICU, where eventually compromised renal function may further affect erythropoiesis via reduced erythropoietin formation and increased circulating hepcidin levels [ 36 , 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Dynamics in Anemia Development and Dysregulation of Iron Homeostasis in Hospitalized Patients with COVID-19

et al. 2021

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Anemia and disturbances of iron metabolism are frequently encountered in patients with COVID-19 and associated with an adverse clinical course. We retrospectively analyzed 645 consecutive COVID-19 patients hospitalized at the Innsbruck University Hospital. Pre-existing anemia was associated with increased risk for in-hospital death. We further found that the decline in hemoglobin levels during hospital stay is more pronounced in patients with signs of hyperinflammation upon admission, the latter being associated with a nearly two-fold higher risk for new onset anemia within one week. Anemia prevalence increased from 44.3% upon admission to 87.8% in patients who were still hospitalized after two weeks. A more distinct decrease in hemoglobin levels was observed in subjects with severe disease, and new-onset anemia was associated with a higher risk for ICU admission. Transferrin levels decreased within the first week of hospitalization in all patients, however, a continuous decline was observed in subjects who died. Hemoglobin, ferritin, and transferrin levels normalized in a median of 122 days after discharge from hospital. This study uncovers pre-existing anemia as well as low transferrin concentrations as risk factors for mortality in hospitalized COVID-19 patients, whereas new-onset anemia during hospitalization is a risk factor for ICU admission. Anemia and iron disturbances are mainly driven by COVID-19 associated inflammation, and cure from infection results in resolution of anemia and normalization of dysregulated iron homeostasis.

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Section: Discussionmentioning

confidence: 99%

Dynamics in Anemia Development and Dysregulation of Iron Homeostasis in Hospitalized Patients with COVID-19

et al. 2021

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“…Also, iatrogenic blood draws lead to loss of blood. In a study, COVID-19 patients in ICU showed a loss of about one third of the total patients’ red blood cell mass because of repeated blood sampling during the ICU stay [ 117 ]. Moreover, these patients may be suffering from pre-existing iron deficiency.…”

Section: Interplay Of Iron Parameters In Covid-19mentioning

confidence: 99%

Iron and iron-related proteins in COVID-19

Suriawinata

Mehta

2022

Clin Exp Med

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COVID-19 can cause detrimental effects on health. Vaccines have helped in reducing disease severity and transmission but their long-term effects on health and effectiveness against future viral variants remain unknown. COVID-19 pathogenesis involves alteration in iron homeostasis. Thus, a contextual understanding of iron-related parameters would be very valuable for disease prognosis and therapeutics.Accordingly, we reviewed the status of iron and iron-related proteins in COVID-19. Iron-associated alterations in COVID-19 reported hitherto include anemia of inflammation, low levels of serum iron (hypoferremia), transferrin and transferrin saturation, and high levels of serum ferritin (hyperferritinemia), hepcidin, lipocalin-2, catalytic iron, and soluble transferrin receptor (in ICU patients). Hemoglobin levels can be low or normal, and compromised hemoglobin function has been proposed. Membrane-bound transferrin receptor may facilitate viral entry, so it acts as a potential target for antiviral therapy. Lactoferrin can provide natural defense by preventing viral entry and/or inhibiting viral replication. Serum iron and ferritin levels can predict COVID-19-related hospitalization, severity, and mortality. Serum hepcidin and ferritin/transferrin ratio can predict COVID-19 severity. Here, serum levels of these iron-related parameters are provided, caveats of iron chelation for therapy are discussed and the interplay of these iron-related parameters in COVID-19 is explained.This synopsis is crucial as it clearly presents the iron picture of COVID-19. The information may assist in disease prognosis and/or in formulating iron-related adjunctive strategies that can help reduce infection/inflammation and better manage COVID-19 caused by future variants. Indeed, the current picture will augment as more is revealed about these iron-related parameters in COVID-19.

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Observational Trialsmentioning

confidence: 95%

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

Helmer

Hottenrott

Steinisch

et al. 2022

JCM

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Background: Anemia remains one of the most common comorbidities in intensive care patients worldwide. The cause of anemia is often multifactorial and triggered by underlying disease, comorbidities, and iatrogenic factors, such as diagnostic phlebotomies. As anemia is associated with a worse outcome, especially in intensive care patients, unnecessary iatrogenic blood loss must be avoided. Therefore, this scoping review addresses the amount of blood loss during routine phlebotomies in adult (>17 years) intensive care patients and whether there are factors that need to be improved in terms of patient blood management (PBM). Methods: A systematic search of the Medline Database via PubMed was conducted according to PRISMA guidelines. The reported daily blood volume for diagnostics and other relevant information from eligible studies were charted. Results: A total of 2167 studies were identified in our search, of which 38 studies met the inclusion criteria (9 interventional studies and 29 observational studies). The majority of the studies were conducted in the US (37%) and Canada (13%). An increasing interest to reduce iatrogenic blood loss has been observed since 2015. Phlebotomized blood volume per patient per day was up to 377 mL. All interventional trials showed that the use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn. Conclusion: Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia. Therefore, a comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes.

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Iatrogenic anaemia and transfusion thresholds in ICU patients with COVID-19 disease at a tertiary care hospital

Cited by 6 publications

References 39 publications

Dynamics in Anemia Development and Dysregulation of Iron Homeostasis in Hospitalized Patients with COVID-19

Dynamics in Anemia Development and Dysregulation of Iron Homeostasis in Hospitalized Patients with COVID-19

Iron and iron-related proteins in COVID-19

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

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