Juárez-Vela Raúl, Andrés-Esteban Eva María, Gea-Caballero Vicente, Sánchez-González Juan Luis, Marcos-Neira Pilar, Serrano-Lázaro Ainhoa, Tirado-Anglés Gabriel, Ruiz-Rodríguez Juan Carlos, Durante Ángela, Santolalla-Arnedo Iván, García-Erce José Antonio, Quintana-Díaz Manuel
Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, 28049 Madrid, Spain.
Research Institute Idi-Paz, PBM Group, 28046 Madrid, Spain.
J Clin Med. 2022 Feb 16;11(4):1031. doi: 10.3390/jcm11041031.
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%, -value = 0.003), venous catheter insertion (87.37% vs. 72.34%, -value = 0.023), drainages (33.68% vs. 12. 77%, -value = 0.038), and ICU stay, where the longer the stay, the higher the rate of iatrogenic anemia (-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.
贫血在重症患者中很常见；几乎95%入住重症监护病房（ICU）的患者血红蛋白水平低于正常。有几个原因可以解释这种现象以及在没有充分理由的情况下给患者输血的倾向：由于不遵守协议、缺乏监督、输血申请表格不完整，或者对输血的适应症、风险和成本缺乏了解。每天取样监测凝血参数和酸碱平衡会加重贫血，这是贫血产生的主要医源性因素。我们研究了医源性失血和其他因素在ICU贫血发生率中的关联及重要性。我们在西班牙的五家医院进行了一项前瞻性、观察性、多中心研究。共有142例患者入住ICU，中位年龄为58岁（四分位间距：48 - 69岁），男性占71.83%，女性占28.17%，入院时未诊断为医源性贫血。在他们入住ICU期间，样本中有66.90%（95例）出现了贫血（95%置信区间：58.51 - 74.56%）。与医源性贫血发生相关的危险因素包括动脉导管插入（72.63%对46.81%，P值 = 0.003）、静脉导管插入（87.37%对72.34%，P值 = 0.023）、引流（33.68%对12.77%，P值 = 0.038）以及ICU住院时间，住院时间越长，医源性贫血发生率越高（P值 < 0.001）。我们得出结论，由于在重症监护病房进行日常实验室监测取样和关键操作导致医源性贫血的发生具有统计学意义。实施患者血液管理计划可以解决这些问题。
