European Heart Journal Advance Access originally published online on September 17, 2007
European Heart Journal 2007 28(20):2551; doi:10.1093/eurheartj/ehm336
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Nosocomial anaemia
Yakum 60972
Israel
Tel: +972 9 9524515 Fax: +972 9 9524637 E-mail address; mliron{at}yakum.co.il
Aronson et al.1 reported their findings on the important long-term prognostic significance of the drop in haemoglobin levels that had developed during hospital stay, in patients with acute myocardial infarction in the intensive coronary care unit (they included only survivors at discharge, so we do not have details on that correlation in the deceased). They discussed the possible causes of that drop and mentioned about bleeding due to pharmacological interventions or invasive procedures.
They did not mention, however, (nor did the editorialist for that matter)2, diagnostic phlebotomy as another possible and important contributor to blood loss which can play a role in causing anaemia in the hospital. The authors did not indicate if a policy of minimizing diagnostic blood loss is practised in their unit. This kind of iatrogenic blood loss is recognized and much discussed, occuring mostly in the premises of intensive care units. In a recent paper on ventilated patients,3 10% of patients had more than 500 cc of blood withdrawn. However, it was shown that in the general medical service too, the amount of blood withdrawn may be significant and that the amount correlated well with the drop observed in haemoglobin during the hospital stay.4
Given the evidence gathered on the possible role of phlebotomy in causing ‘nosocomial anaemia’ and on the presumed contributory role of that anaemia to prognosis worsening, it seems that the goals of patient safety and quality of care dictate for measures of blood conservation in this domain to be taken and enforced everywhere. The first step is indeed the awareness of the hospital team, and possible measures are, for example, restraining of the frequency of sampling to the minimum necessary, frequent checks for superfluous ‘routines’, the use of small volume blood containers, etc.3
References
- Aronson D, Suleiman M, Agmon Y, Suleiman A, Blich M, Kapeliovich M, Beyar R, Markiewicz W, Hammerman H. Changes in haemoglobin levels during hospital course and long-term outcome after acute myocardial infarction. Eur Heart J (2007) 28:1289–1296.
[Abstract/Free Full Text] - Bassand JP. Impact of anaemia, bleeding, and transfusions in acute coronary syndromes: a shift in the paradigm. Eur Heart J (2007) 28:1273–1274.
[Free Full Text] - Shaffer C. Diagnostic blood loss in mechanically ventilated patients. Heart Lung (2007) 36:217–222.[CrossRef][Web of Science][Medline]
- Thavendiranathan P, Bagai A, Ebidia A, Detsky AS, Choudhry NK. Do blood tests cause anemia in hospitalized patients? The Effect of diagnostic phlebotomy on hemoglobin and hematocrit levels. J Gen Intern Med (2005) 20:520–524.[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||