NoBlood

Anemia, transfusion and phlebotomy practices in critically ill patients with prolonged ICU length-of-stay: a cohort study

Critical Care 2006, 10:R140 doi:10.1186/cc5054
Clarence Chant (chantc@smh.toronto.on.ca)
Gail Wilson (wilsong@smh.toronto.on.ca)
Jan O Friedrich (j.friedrich@utoronto.ca)

From the Specialized Complex Care Program1, Pharmacy Department2, Critical Care and Medicine Departments3, St Michael’s Hospital and Leslie Dan Faculty of Pharmacy4 and Interdepartmental Division of Critical Care5, University of Toronto, Toronto, Ontario,
Canada

Abstract
Introduction: Anemia in critically-ill patients has been described in patients with short to medium lengths-of-stay in the intensive care unit (ICU). This has not been described in long-stay ICU patients. This study was performed to characterize anemia, transfusion and phlebotomy practices in patients with a prolonged ICU length-of-stay (LOS).
Methods: Retrospective chart review of consecutive patients admitted to a Medical-Surgical ICU in a tertiary-care university hospital over 3 years with a continuous LOS 30 or more days. Information on transfusion, phlebotomy, and outcomes were collected daily from day 22 up to 112 of ICU stay.
Results: 155 patients were enrolled. The mean age, admission APACHE II score, and median ICU LOS were 62.3ｱ16.3 years, 23ｱ8, and 49 days (interquartile range 36-70), respectively. Mean hemoglobin (HGB) remained stable at 9.0ｱ1.2 g/dL from day 7 onward. Mean daily phlebotomy volume was 13.3ｱ7.3 mL, and 62% of patients received a mean of 3.4ｱ5.3 units of packed red blood cells (PRBC) at a mean HGB trigger of 7.7 +/- 9.0 g/dL after day 21. Transfused patients had significantly higher illness acuity, phlebotomy volumes, ICU LOS, and mortality and a lower HGB than those who were not transfused. Multivariate logistic regression analysis identified the following as independently associated with the probability of requiring transfusion in non-bleeding patients: baseline HGB, daily phlebotomy volume, ICU LOS, and erythropoietin therapy (used almost exclusively in dialysis-dependent renal failure in this cohort of patients). Small increases in average phlebotomy (3.5 mL/day, 95%C.I. 2.4 to 6.8) were associated with a doubling of the odds of being transfused after day 21.
Conclusions: Anemia, phlebotomy, and transfusions despite low HGB triggers are common in ICU patients long after admission. Small decreases in phlebotomy are associated with significantly reduced transfusion requirements in patients with prolonged
ICU LOS.