‘Sepsis-related anemia’ is absent at hospital presentation; a retrospective cohort analysis

Abstract

BackgroundAnemia is a common feature during sepsis that occurs due to iatrogenic blood loss, depression of serum iron levels and erythropoietin production, and a decreased lifespan of erythrocytes. However, these mechanisms are unlikely to play a role in anemia at the start of sepsis. Moreover, sequestration of fluids, renal failure and increase of intravascular space may additionally influence the change in hemoglobin concentration during intravenous fluid administration in the acute phase of sepsis.MethodsIn this retrospective study, patients who were admitted acutely to the Intensive Care Unit (ICU) were included. Patients who fulfilled the international criteria for severe sepsis or septic shock were included in the sepsis group (S-group). The remaining patients were allocated to the control group (C-group). Laboratory data from blood samples taken at first presentation to the hospital and at admission to the ICU, the amount of intravenous fluid administration and length of stay in the emergency department were collected and tested for significant differences between groups.ResultsThe difference in hemoglobin concentration between the S-group (n = 296) and C-group (n = 320) at first presentation in hospital was not significant (8.8 ± 1.2 versus 8.9 ± 1.2 mmol/l, respectively, p = 0.07). The reduction in hemoglobin concentration from the first presentation at the emergency department to ICU admission was significantly greater in the S-group compared to the C-group (1 [0.5-1.7] versus 0.5 [0.1-1.1] mmol/l, (p < 0.001)). Spearman rho correlation coefficients between the reduction in hemoglobin concentration and the amount of intravenous fluids administered or the creatinine level in the emergency department were significant (0.3 and 0.4, respectively, p < 0.001). In a multivariate regression analysis, creatinine, the amount of fluid administration and the presence of sepsis remained independently associated.ConclusionsPrior to in-hospital intravenous fluid administration, there is no significant difference in hemoglobin concentration between acute septic patients and acutely ill controls. Within several hours after hospital admission, there is a significant reduction in hemoglobin concentration, not only associated with the amount of intravenous fluids administered and the creatinine level, but also independently with sepsis itself.

Bacterial Lipopolysaccharides Suppress Erythroblastic Islands and Erythropoiesis in the Bone Marrow in an Extrinsic and G- CSF-, IL-1-, and TNF-Independent Manner

“…Whole blood counts at 48 h after LPS administration showed dramatic increases in neutrophils, monocytes, eosinophils, basophils ( Supplementary Figures 3B–E ) and significant reduction in lymphocytes and platelets ( Supplementary Figures 3F,G ). Of note, due to the 40-day half-life of mouse erythrocytes, erythrocytes numbers and volumes, hematocrit and hemoglobin concentrations were not affected at this early time-point after LPS challenge ( Supplementary Figures 3H–L ) consistent with the lack of anemia in the early stage of sepsis in human patients ( 14 ).…”

“…In the particular case of sepsis, patients are generally not anemic at admission to emergency department but develop anemia once admitted to intensive care units ( 14 ). It has been proposed that anemia of sepsis is correlated with (a) intravenous fluid administration during intensive care, which may dilute erythrocytes and hemoglobin of sepsis patients and (b) renal failure ( 14 ).…”

“…In the particular case of sepsis, patients are generally not anemic at admission to emergency department but develop anemia once admitted to intensive care units ( 14 ). It has been proposed that anemia of sepsis is correlated with (a) intravenous fluid administration during intensive care, which may dilute erythrocytes and hemoglobin of sepsis patients and (b) renal failure ( 14 ). In mouse models of acute sepsis involving the systemic administration of bacterial endotoxin such as lipopolysaccharides (LPS), bacterial endotoxins reduce the number of nucleated erythroid cells and reticulocytes and suppress erythropoiesis and iron incorporation in the bone marrow (BM) whilst increasing splenic stress erythropoiesis ( 15 , 16 ).…”

Decrease of HC and Hypoproteinemia: Possible Predictors of Complication of Neonatal Sepsis in a Developing Country?

“…Many causes can lead anemia, such as iatrogenic blood loss, reduced serum iron levels, shortened red blood cell life and increased destruction, etc. In addition, vascular endothelial glycocalyx shedding and intravenous uid administration lead to blood thinning [11][12][13] , which is also manifested by a decrease in HC, causing thinning 'anemia'. But in the early stage of sepsis, the decrease of HC is mostly caused by increased destruction of red blood cells and damage to the glycocalyx layer.…”

Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial

“…In the clinical setting, red cell concentration has been recommended as a guide for fluid replacement in systemic inflammatory diseases such as pancreatitis [ 14 – 16 ] and burn injury [ 17 ]. However, few clinical studies have specifically assessed changes in haemoglobin concentration during resuscitation from septic shock [ 18 , 19 ], and the extent to which this may be related to intravenous fluid volume remains uncertain.…”