Practice Trends in the Management of Low Hematocrit in the Acute Rehabilitation Setting

Abstract

To examine current clinical practice regarding the management of anemic patients in the acute rehabilitation setting. Ninety-four medical directors of inpatient rehabilitation units were surveyed on their use of transfusion thresholds and human recombinant erythropoietin. Factors affecting their clinical decision making were assessed. The majority of physicians responded that they recommend red cell transfusion in patients with a hematocrit <25%. When a history of cardiovascular disease and advanced age was present, more physicians were likely to transfuse at higher hematocrit levels. Forty-six percent of physicians reported recommending the use of human recombinant erythropoietin in anemic patients. Only 30% of respondents classified their clinical management of anemia as evidence based. Clinical practice guidelines should be developed to aid the rehabilitation medicine specialist in the management of anemic patients in the acute rehabilitation setting. Further study of the relationship between hematocrit level, tolerance for therapeutic exercise, and long-term functional outcome is indicated.