Simulation of repetitive diagnostic blood loss and onset of iatrogenic anemia in critical care patients with a mathematical model

Lyon, Andrew W.; Chin, Alex; Slotsve, George A.; Lyon, Martha E.

doi:10.1016/j.compbiomed.2012.11.008

Cited by 57 publications

(34 citation statements)

References 27 publications

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“…Blood losses associated to venous samples and hemodialysis must be taken into account [19]. However, as mentioned above, as only 6.7 % of our patient group received hemodialysis, we do not believe that blood loses associated to this type of RRT constituted any bias to our results.…”

Section: Discussionmentioning

confidence: 89%

Relationship between red blood cell transfusion requirements and severity of renal disease during the acute stage of hemolytic uremic syndrome

et al. 2015

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Section: Discussionmentioning

confidence: 89%

Relationship between red blood cell transfusion requirements and severity of renal disease during the acute stage of hemolytic uremic syndrome

et al. 2015

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“…Lyon et al suggested a mathematical model that can be used to anticipate hemoglobin level decrement in patients who are exposed to repetitive diagnostic blood loss due to blood sampling [31]. The model takes into account two factors contributing to hemoglobin loss: red blood cell senescence and diagnostic blood loss due to phlebotomy.…”

Section: Prevention Of Iatrogenic Anemia In Intensive Care Unitsmentioning

confidence: 99%

Prevention of Iatrogenic Anemia in Critical and Neonatal Care

Jakacka¹,

Snarski²,

Mekuria³

2015

Adv Clin Exp Med

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Iatrogenic anemia caused by diagnostic blood sampling is a common problem in the intensive care unit, where continuous monitoring of blood parameters is very often required. Cumulative blood loss associated with phlebotomy along with other factors render this group of patients particularly susceptible to anemia. As it has been proven that anemia in this group of patients leads to inferior outcomes, packed red blood cell transfusions are used to alleviate possible threats associated with low hemoglobin concentration. However, the use of blood components is a procedure conferring a set of risks to the patients despite improvements in safety. Iatrogenic blood loss has also gained particular attention in neonatal care, where cumulative blood loss due to samples taken during the first week of life could easily equal or exceed circulating blood volume. This review summarizes the current knowledge on the causes of iatrogenic anemia and discusses the most common preventive measures taken to reduce diagnostic blood loss and the requirement for blood component transfusions in the aforementioned clinical situations (Adv Clin Exp Med 2016, 25, 1, 191-197).

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“…Since it has been estimated to take 15 days of daily phlebotomy of 53 mL of whole blood in females of average body weight (and 20 days for average weight males) with no bone marrow synthesis for severe anemia to develop, it is even less likely that phlebotomy was the principal etiology given an 8-day median LOS among patients with severe HAA. 19,20 However, since the etiology of HAA can be multifactorial, limiting blood loss due to phlebotomy by using smaller volume tubes, blood conservation devices, or reducing unnecessary testing may mitigate the development of severe HAA. 21,22 Additionally, since more than three-quarters of patients who developed severe HAA underwent a major procedure, more care and attention to minimizing operative blood loss could lessen the severity of HAA and facilitate better recovery.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Predictors, and Outcomes of Hospital‐Acquired Anemia

Makam

Nguyen

Clark

et al. 2017

Journal of Hospital Medicine

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BACKGROUND Although hypothesized to be a hazard of hospitalization, it is unclear whether hospital‐acquired anemia (HAA) is associated with increased adverse outcomes following discharge. OBJECTIVE To examine the incidence, predictors, and postdischarge outcomes associated with HAA. DESIGN Observational cohort study using electronic health record data. SUBJECTS Consecutive medicine discharges between November 1, 2009 and October 30, 2010 from 6 Texas hospitals, including safety‐net, teaching, and nonteaching sites. Patients with anemia on admission or missing hematocrit values at admission or discharge were excluded. MEASURES HAA was defined using the last hematocrit value prior to discharge and categorized by severity. The primary outcome was a composite of 30‐day mortality and nonelective readmission. RESULTS Among 11,309 patients, one‐third developed HAA (21.6% with mild HAA; 10.1% with moderate HAA; and 1.4% with severe HAA). The 2 strongest potentially modifiable predictors of developing moderate or severe HAA were length of stay (adjusted odds ratio [OR], 1.26 per day; 95% confidence interval [CI], 1.23‐1.29) and receipt of a major procedure (adjusted OR, 5.09; 95% CI, 3.79‐6.82). Patients without HAA had a 9.7% incidence for the composite outcome versus 16.4% for those with severe HAA. Severe HAA was independently associated with a 39% increase in the odds for 30‐day readmission or death (95% CI, 1.09‐1.78). Most patients with severe HAA (85%) underwent a major procedure, had a discharge diagnosis of hemorrhage, and/or a discharge diagnosis of hemorrhagic disorder. CONCLUSIONS Severe HAA is associated with increased odds for 30‐day mortality and readmission after discharge; however, it is uncertain whether severe HAA is preventable.

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Simulation of repetitive diagnostic blood loss and onset of iatrogenic anemia in critical care patients with a mathematical model

Cited by 57 publications

References 27 publications

Relationship between red blood cell transfusion requirements and severity of renal disease during the acute stage of hemolytic uremic syndrome

Relationship between red blood cell transfusion requirements and severity of renal disease during the acute stage of hemolytic uremic syndrome

Prevention of Iatrogenic Anemia in Critical and Neonatal Care

Incidence, Predictors, and Outcomes of Hospital‐Acquired Anemia

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