Czempik Piotr F, Wilczek Dawid, Herzyk Jan, Krzych Łukasz J
Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
J Clin Med. 2022 Jul 6;11(14):3939. doi: 10.3390/jcm11143939.
Hospital-acquired anemia (HAA) is prevalent in patients hospitalized in the intensive care unit (ICU). Iatrogenic blood loss (IBL) may aggravate existing anemia or lead to a need for red blood cell (RBC) transfusion. The aim of our study was to analyze hemoglobin (Hb) concentration changes in up to 14 days, as well as all potential sources of IBL, in consecutive patients admitted to the intensive care unit (ICU) in the years 2020−2021. Patients admitted due to bleeding were excluded. Anemia on admission was present in 218 (58.8%) patients—47 (48.9%) surgical and 171 (62.2%) non-surgical (p = 0.02). Gradual decrease in Hb was seen in all ICU patients. Eighty-one (21.8%) patients required RBC transfusion. The first unit of RBC was transfused on day 7 (IQR 2−13) and the second on day 11 (IQR 4−15) of ICU hospitalization. The median admission Hb in patients who required RBC transfusion was 10.2 (IQR 8.5−11.8) and, in those who did not require transfusion, it was 12.0 (IQR 10.2−13.6) g/dL (p < 0.01). Anemia on admission was associated with a need for RBC transfusion (p < 0.01). Average decrease in Hb during the first week of ICU hospitalization in patients with and without anemia on admission was 1.2 (IQR 0.2−2.3) and 2.8 (IQR 1.1−3.8) g/dL (p < 0.01), respectively. Percentage of patients who bled at the insertion site of invasive devices was as follows: percutaneous tracheostomy—46.7%, therapeutic plasma exchange (TPE) catheter—23.8%, dialysis catheter—13.3%, gastrostomy—9.5%, central venous catheter—7.8%. Moreover, circuit clotting occurred in 17.7 and 9.5% of patients undergoing dialysis and TPE, respectively. Median blood loss for repeated laboratory testing in our study population was 13.7 (IQR 9.9−19.3) mL per patient daily. Anemia is highly prevalent among medical and surgical patients on admission to ICU and is associated with RBC transfusion. Patients who required RBC transfusion had significantly lower daily Hb concentrations. Severity of disease did not seem to have impact on Hb concentration. IBL associated with invasive devices and extracorporeal therapies is frequent in ICU patients and may lead to a gradual decrease in Hb concentration. Further studies are required to analyze causes of HAA in the ICU.
医院获得性贫血（HAA）在入住重症监护病房（ICU）的患者中很常见。医源性失血（IBL）可能会加重现有的贫血或导致需要输注红细胞（RBC）。我们研究的目的是分析2020 - 2021年期间连续入住重症监护病房（ICU）的患者在长达14天内血红蛋白（Hb）浓度的变化以及IBL的所有潜在来源。因出血入院的患者被排除在外。218例（58.8%）患者入院时存在贫血，其中47例（48.9%）为外科手术患者，171例（62.2%）为非外科手术患者（p = 0.02）。所有ICU患者的Hb均呈逐渐下降趋势。81例（21.8%）患者需要输注RBC。在ICU住院的第7天（四分位间距2 - 13）输注了第一单位的RBC，第11天（四分位间距4 - 15）输注了第二单位。需要输注RBC的患者入院时Hb中位数为10.2（四分位间距8.5 - 11.8）g/dL，不需要输血的患者为12.0（四分位间距10.2 - 13.6）g/dL（p < 0.01）。入院时贫血与需要输注RBC相关（p < 0.01）。入院时有贫血和无贫血的患者在ICU住院第一周期间Hb的平均下降分别为1.2（四分位间距0.2 - 2.3）和2.8（四分位间距1.1 - 3.8）g/dL（p < 0.01）。侵入性设备插入部位出血的患者百分比分别为：经皮气管切开术——46.7%，治疗性血浆置换（TPE）导管——23.8%，透析导管——13.3%，胃造口术——9.5%，中心静脉导管——7.8%。此外，分别有17.7%和9.5%接受透析和TPE的患者发生回路凝血。我们研究人群中重复进行实验室检测的中位数失血量为每位患者每天13.7（四分位间距9.9 - 19.3）mL。贫血在入住ICU的内科和外科患者中非常普遍，并且与RBC输血相关。需要输注RBC的患者每日Hb浓度明显较低。疾病严重程度似乎对Hb浓度没有影响。与侵入性设备和体外治疗相关的IBL在ICU患者中很常见，可能导致Hb浓度逐渐下降。需要进一步研究以分析ICU中HAA的原因。
