Call for action on anaemia in hospitalised patients

Wednesday, 14 Nov 2018

Anaemia is a common but overlooked problem in hospitalised patients and is linked to higher rates of mortality and length of stay, a study from WA shows.

Anaemia was reported during hospital stays in more than half (57%) of 80,765 admissions at the Royal Perth Hospital between 2010 and 2015, the retrospective review found.

Published in the journal Transfusion, the analysis showed that (66.5%) of the cases were mild anaemia (100-119 g/L in women and 100-129 g/L in men) and 33.5% moderate to severe anaemia and moderate to severe (≤100 g/L). In addition, in more than a third of cases (37%) anaemia onset occurred after admission.

Anaemia was also found to be  associated with poor outcomes, including higher rates of in-hospital mortality (Odds Ratio 1.5 for mild to moderate anaemia, OR 2.8 for moderate to severe anaemia) and length of stay (OR 1.3 and 1.7 respectively).

Length of stay was longer for patients who developed anaemia after admission (OR 1.13) compared to those with anaemia on admission.

Red cell transfusion was independently associated with a 2.2 times higher odds of in-hospital mortality and 1.3 times longer length of stay.

The study investigators said there were many complex and multifactorial reasons why a patient’s haemoglobin level may decrease during hospitalisation, including anaemia related to disease and inflammation, as well as iatrogenic factors.

“Plasma volume expansion with resultant haemodilution can take place with administration of vasodilators and intravenous fluids. Hb levels can fluctuate and fall because of various stressors, disease states, and neuroendocrine responses,” they noted.

The finding that even mild anaemia was associated with poor outcomes showed there was a pressing need for greater awareness and vigilance for the condition in hospitalised patients, they said.

“Anaemia in hospitalised patients is under-acknowledged, misinterpreted, and increasingly iatrogenic,” they concluded.

“The findings of our study suggest that anaemia identification, evaluation, and management for all hospitalised patients may need to become a new standard of care.”

To remedy the situation in WA, hospital clinicians are urging GPs to use the time when patients are on elective surgery waiting lists to identify anaemia and ‘supercharge’ their blood if necessary before admission.

Study co-author Dr Michael Leahy, a haematologist at the Royal Perth Hospital, has advised referring doctors to be aware of risk factors for anaemia in their pre-operative patients, perform blood, iron and ferritin tests where appropriate and manage anaemia accordingly.

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