Abstract
Anemia is common in critically ill patients; almost 95% of patients admitted to intensive care units (ICUs) have hemoglobin levels below normal. Several causes may explain this phenomenon as well as the tendency to transfuse patients without adequate cause: due to a lack of adherence to protocols, lack of supervision, incomplete transfusion request forms, or a lack of knowledge about the indications, risks, and costs of transfusions. Daily sampling to monitor the coagulation parameters and the acid–base balance can aggravate anemia as the main iatrogenic factor in its production. We studied the association and importance of iatrogenic blood loss and other factors in the incidence of anemia in ICUs. We performed a prospective, observational, multicenter study in five Spanish hospitals. A total of 142 patients with a median age of 58 years (IQI: 48–69), 71.83% male and 28.17% female, were admitted to ICUs without a diagnosis of iatrogenic anemia. During their ICU stay, anemia appeared in 66.90% of the sample, 95 patients, (95% CI: 58.51–74.56%). Risk factors associated with the occurrence of iatrogenic anemia were arterial catheter insertion (72.63% vs. 46.81%, p-value = 0.003), venous catheter insertion (87.37% vs. 72.34%, p-value = 0.023), drainages (33.68% vs. 12. 77%, p-value = 0.038), and ICU stay, where the longer the stay, the higher the rate of iatrogenic anemia (p-value < 0.001). We concluded that there was a statistical significance in the production of iatrogenic anemia due to the daily sampling for laboratory monitoring and critical procedures in intensive care units. The implementation of patient blood management programs could address these issues.
Highlights
Anemia is very common in critically ill patients [1]; almost 95% of patients admitted to intensive care units (ICU) have hemoglobin levels below normal [2]
Medical reasons accounted for only 5.63% of ICU admissions (Table 1)
In a recent study published by Warner et al [22], in a cohort of 6901 adults hospitalized in the ICU, 41% had anemia before hospitalization, a value slightly lower than that obtained in our study
Summary
Anemia is very common in critically ill patients [1]; almost 95% of patients admitted to intensive care units (ICU) have hemoglobin levels below normal [2]. Since 2010, blood donations have fallen by 6.6% despite an increase in the global population, all while there has been an increase in the consumption of albumin and immunoglobulins of 58% and 99.6%, respectively, since 2012 This has led to shortages in blood, blood components, and blood products in some countries [8,9,10]. The inappropriate use of these limited resources is associated with increased respiratory distress, cardiac overload, iatrogenic infections, and hemolysis. This has led to longer hospital stays and complications derived from the transfusions themselves [12] as well as financial burdens and poor outcomes. The objective of this study was to estimate the prevalence of iatrogenic anemia in critically ill patients and identify the factors associated
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