Anemia in ICU - Dr Alok Nath Department of Pulmonary...

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Dr Alok Nath Department of Pulmonary Medicine PGIMER Chandigarh A common occurrence in ICUs Mostly managed with blood transfusions. Transfusion requirements increasing In the United States nearly 15 million units are donated and 14 million units transfused annually Increased cost due to increasing requirements and rigorous screening procedures
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16 % of the medical ICUs and 27 % of the surgical ICU patients receive transfusions daily in the USA A number of studies have documented the prevalence of anemia in critically ill patients and high rate of transfusion requirements in the ICU Corwin et al 1997 Crit Care Med More than 90% of critically ill patients have subnormal hemoglobin 3rd day past the stay in the ICU Corwin et al 1995 Chest In one series the mean Hb of patients in ICU was 11.3 gm/dl with 29 % having Hb levels < 10 gm/dl 85 % of the patients with an ICU stay of >1 week received blood transfusion with a mean of 9.5 ± 0.8 units/patient The reason for transfusion was not clear in about 29 % of the patients Von Ahsen N et al Crit Care Med 1999
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The ABC trial 3534 patients Mean Hb 11.3 ± 2.3 gm/dl 29 % - Hb < 10gm/dl Transfusion rate 37% Surgical patients - more transfusion Stay more than 7 days- 73% received transfusion Overall mean pretransfusion Hb 8.4 ± 1.3gm/dl The CRIT study 4892 patients; 284 ICUS Mean baseline Hb 11.0 ± 2.4 gm/dl Mean decrease to 9.8 ± 1.4 gm/dl(p< 0.0045) 44% transfused during ICU stay(4.6 ± 4.9 units per patient) Stay > 7 days More transfusion(63% vs 33.4%;p<0.0001) Mean pretransfusion Hb 8.6 ± 1.7gm/dl
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Post hoc analysis of CRIT study patients Mean baseline Hb 11.1 ± 2.4 gm/dl Higher transfusion rate in post op trauma patients 55.4% patients transfused(5.8 ± 5.5 units) Mean pretransfusion Hb 8.9 ± 1.8 gm/dl 1247 patients 666(53%) received transfusions Transfused patients - higher mortality Average pretransfusion Hb 9gm/dl in 75% of transfusion episodes 72% patients transfused for low Hb rest for hemorrhage Rao et al Anaesthesia 2002 Study TRICC Investigators (Canada) 1998 ABC trial( (Western Europe) 2002 North Thames Blood Interest Group (UK) 2002 CRIT Study (USA) 2004 n 5298 3534 1247 4892 Mean admission Hb (g/dl) 9.9 ± 2.2 11.3 ± 2.3 11.0 ± 2.4 Percentage of patients transfused in ICU 25% 37% 53.4% 44.1% Mean transfusions per patient (units) 4.6 ± 6.7 4.8 ± 5.2 5.7 ± 5.2 4.6 ± 4.9 Mean pretransfusion Hb(g/dl) 8.6 ± 1.3 8.4 ± 1.3 8.5 ± 1.4 8.6 ± 1.7 Mean ICU length of stay (days) 4.8 ± 12.6 4.5 7.4 ± 7.3 ICU mortality 22% 13.5% 21.5% 13% Hospital mortality 20.2% 17.6% Admission APACHE II (mean) 18 ± 11 14.8 ± 7.9 18.1 ± 9.1 19.7 ± 8.2
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Nguyen and colleagues (n = 91) Prospective, single-institution observational study Fall in Hb concentrations averaged 0.52 ± 0.69 g/dl per day After the 3rd ICU day the change in Hb concentrations was inversely proportional to APACHE II and SOFA scores Hb concentrations decreased by 0.44 ± 0.70 g/dl per day in the non septic patients and 0.68 ± 0.66 g/dl per day in the septic
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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Anemia in ICU - Dr Alok Nath Department of Pulmonary...

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