Anemia in hospitalized patients: an overlooked risk in medical care

Krishnasivam, Deepan; Trentino, Kevin M.; Burrows, Sally; Farmer, Shannon; Picardo, Sherman; Leahy, Michael F.; Halder, Abir; Chamberlain, Jenny; Swain, Stuart G.; Muthucumarana, Kalindu; Waterer, Grant

doi:10.1111/trf.14877

Cited by 25 publications

(28 citation statements)

References 34 publications

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“…Previous studies suggest that anemia in patients is associated with increased inpatient admissions, length of hospitalization, and outpatient visits compared with non-anemic patients. [29][30][31] This may be attributable to comorbid diseases, as well the recognized clinical consequences of IDA, such as dyspnea and vertigo. 4,[29][30][31] IDA can also impact cognitive function and worsen comorbid diseases, [5][6][7] which may require further prolonged health care assistance.…”

Section: Discussionmentioning

confidence: 99%

Importance of Initial Complete Parenteral Iron Repletion on Hemoglobin Level Normalization and Health Care Resource Utilization: A Retrospective Analysis

LaVallee¹,

Cronin²,

Bansal³

et al. 2019

Pharmacotherapy

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Study Objective Iron deficiency anemia is the most common form of anemia, and parenteral iron therapy is necessary in select patients. The objective of this analysis was to assess the impact of initial complete parenteral iron repletion on serum hemoglobin (Hgb) level normalization and on health care resource utilization in real‐world practice. Design Retrospective observational study. Data Source Decision Resources Group Real‐World Data Repository (United States databases). Patients A total of 2966 patients who had a baseline Hgb level below normal (< 12 g/dl for females and < 13.5 g/dl for males) and were treated with parenteral iron between March 2015 and February 2017. Measurements and Main Results The effect of receiving the required parenteral iron dose to replete the deficit, calculated by a modified Ganzoni formula, within 3 weeks of the first parenteral iron therapy claim (index date) on the likelihood of Hgb level normalization, was estimated by using logistic regression. All analyses were adjusted for sex, age, comorbidities, and use of prescription oral iron therapy. The adjusted mean numbers of all‐cause inpatient admissions, outpatient visits, and emergency department (ED) visits within 6 months and 1 year after the index date were compared between patients with and without normalized Hgb levels by using negative binomial regression. Of the 2966 included patients, 33.9% received the required iron dose within 3 weeks of the index date, and 19.6%, 48.2%, and 53.9% had a normalized Hgb level within 8 weeks of the index date, within 1 year of the index date, and until the end of data availability, respectively. Patients who received the required iron dose within 3 weeks of the index date were significantly more likely to have a normalized Hgb level within 8 weeks of the index date and at any time during the study period than those who did not: adjusted odds ratio (OR) (95% confidence interval [CI]) 2.67 (2.20, 3.24) and 2.33 (1.96, 2.77), respectively. Hgb level normalization within 1 year of the index date was associated with fewer inpatient admissions and outpatient visits and a similar number of ED visits compared with no Hgb level normalization 1 year after the index date. Conclusion The results of these analyses underscore the importance of initial complete parenteral iron repletion for rapidly improving clinical outcomes. Prompt achievement of a normalized Hgb level may also provide an opportunity to reduce health care resource utilization in patients with iron deficiency anemia receiving parenteral iron therapy.

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Section: Discussionmentioning

confidence: 99%

Importance of Initial Complete Parenteral Iron Repletion on Hemoglobin Level Normalization and Health Care Resource Utilization: A Retrospective Analysis

LaVallee¹,

Cronin²,

Bansal³

et al. 2019

Pharmacotherapy

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“…Other methods to reduce bleeding or manage anemia should be implemented. These include but are not limited to use of intraoperative cell salvage in surgical cases with blood loss anticipated at greater than 500 mL, use of antifibrinolytic medications to enhance clot stability, use of acute normovolemic hemodilution (ANH) when appropriate, and identifying and treating iron deficiency anemia in patients with severe anemia due to iron deficiency 3 …”

Section: Responsementioning

confidence: 99%

How do I manage long‐term blood component shortages in a hospital transfusion service?

et al. 2020

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“…(1), and hospital acquired anemia often adds to the problem (2). In most cases, anemia is not considered a clinically signi cant condition, remains unnoticed, and therefore uncorrected in hospitalized patients.…”

Section: Introductionmentioning

confidence: 99%

Call to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

Hofmann

Spahn

Holtorf

2020

Preprint

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BackgroundMillions of hospitalized patients are anemic. However, anemia is an independent risk factor for adverse outcomes including morbidity and mortality. In combination with blood loss, anemia is the main driver for transfusion, thus adding risk for adverse outcomes. Patient Blood Management (PBM) is a concept to identify and correct anemia and to minimize blood loss. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. By gathering the experiences of a diverse group of PBM implementors across countries with different healthcare contexts, we aimed to identify the drivers, barriers, measures, and stakeholders regarding the implementation of PBM. The synthesis of this information should provide a matrix of complementary measures, allowing PBM stakeholders from diverse professional backgrounds to initiate and orchestrate PBM implementation.MethodsSemi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses were summarized per country, and key observations extracted. By defining the levels of intervention for PBM implementation and applying the Donabedian Quality Framework, we created and populated a matrix of key measures and outcomes as identified from the interviews.ResultsWe were able to extract a set of structural and procedural PBM implementation measures from interviews with the implementors. We created a matrix addressing six levels of implementation including government, healthcare providers (HCP), funding, research, training/education and patients and identified structural and procedural measures on each level. ConclusionThis matrix helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to independently initiate and develop strategies to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.

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Anemia in hospitalized patients: an overlooked risk in medical care

Cited by 25 publications

References 34 publications

Importance of Initial Complete Parenteral Iron Repletion on Hemoglobin Level Normalization and Health Care Resource Utilization: A Retrospective Analysis

Importance of Initial Complete Parenteral Iron Repletion on Hemoglobin Level Normalization and Health Care Resource Utilization: A Retrospective Analysis

How do I manage long‐term blood component shortages in a hospital transfusion service?

Call to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

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