Hospital-Acquired Anemia: When Blood Testing Is Too Much Of A Good Thing
Researchers at UT Southwestern Medical Center have been looking into the reasons why patients return to hospitals within 30 days.
Results in 2016 focused on patients discharged with unstable vital signs. The latest study of six North Texas hospitals found a high rate of hospital-acquired anemia or a loss of red blood cells.
Dr. Anil Makam is an assistant professor of Internal Medicine and Clinical Sciences and a member of the Center for Patient-Centered Outcomes Research at UT Southwestern Medical Center.
What causes hospital-acquired anemia: “The two main reasons that we found for why people develop hospital-acquired anemia in the hospital are undergoing a major surgery or being in the hospital for a long time. While it’s intuitive why people lose blood during a major surgery, it’s often underappreciated the cumulative blood loss from repeated blood tests while people are in the hospital — especially if they’re there for a long period of time.”
Purpose of the UT Southwestern study: “[To learn] how common the severe hospital-acquired anemia occurred; what were the causes of hospital-acquired anemia; and what were the consequences of people who developed hospital-acquired anemia, particularly when they left the hospital and went home."
Results: "We included a combination of community and academic-based teaching hospitals in North Texas. We included over 11,000 hospitalizations, and we found hospital-acquired anemia occurred in one-third of all hospitalizations. Typically, the severity was mild or moderate. However, we found that up to 1 to 2 percent of all patients, these folks developed severe acquired- hospital anemia, which was equivalent to losing three to four pints of blood."
That’s a high rate: “Especially in a short period of time. But fortunately, the severe hospital-acquired anemia doesn’t occur as common as mild or moderate. But what we found is when people lose that amount of blood during their hospital course, they were more likely to have come back to the hospital within 30 days after they initially left, or they actually died during that 30-day window.”
Why a patient might leave the hospital with anemia: “Anemia is oftentimes considered as a change in their blood count, but doesn’t necessarily translate into people feeling worse. So if people don’t necessarily feel bad at the time – if the blood loss has stopped, meaning that they’re done with their surgery or they’re not going through more blood tests — often, we think, we’ll send them home and they’ll get better. What our study shines a light on is that these incidental changes in their blood count might not be incidental, and they have consequences that are often underappreciated in terms of monitoring them more closely and repeating their blood counts once they leave the hospital.”
Prevention: “Our study doesn’t establish direct preventability, but what our findings do suggest is that to mitigate or to lessen the effects of hospital-acquired anemia, minimizing or reducing blood loss from serial blood testing during the hospital stay is one possible way to prevent or mitigate hospital-acquired anemia.”
Too many blood tests are being performed? “Blood testing is extremely useful to make a diagnosis and monitor how people are recovering in responding to therapies. However, during the course of a hospitalization, as patients become stable and are improving, the utility of getting a daily or twice-daily blood test becomes much lower. And I think what’s underappreciated is the cumulative blood loss from all those daily testings, especially for people in the hospital for a long period of time."
One more thing: "I think our study encourages patients and families to ask doctors what’s the value of getting daily blood tests, especially if they feel like they’re getting better.”
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