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ICU Anemia
Aka: ICU Anemia, Anemia in the Intensive Care Unit, Anemia of Critical Illness, Anemia Following ICU Admission
- See Also
- Intensive Care
- Post-ICU Ambulatory Care
- Anemia of Chronic Disease (Anemia of Inflammation)
- Epidemiology
- Hemoglobin drops on average 1.5 g/dl in non-bleeding ICU patients within first 3 days of care
- Supine position alone results in hemodilution (interstitial fluid enters vasculature)
- Supine position drops Hematocrit 4.1% (Hemoglobin 1.4 g/dl)
- Jacob (2005) Mayo Clin Proc 80:611-4 [PubMed]
- In septic patients, Hemoglobin continues a downward trend (whereas it stabilizes in non-septic patients)
- Nguyen (2003) Crit Care Med 31:406-10 +PMID:12576944 [PubMed]
- Risk Factors
- Malignancy
- Sepsis
- Female Gender
- Advanced Age
- Causes: Acute Anemia with Markedly Decreasing Hemoglobin
- Active bleeding
- Hemolysis
- Causes: Gradually Decreasing of Chronic Anemia
- See Medication Causes of Marrow Toxicity
- Hematopoiesis suppressed
- Anemia of Inflammation (Anemia of Chronic Disease)
- Poor nutritional intake in the Intensive Care unit
- Sepsis
- Stress Ulcer
- Frequent blood draws in Critical Illness (40-70 ml/day in Critical Illness)
- In one week, blood draw related losses approach one unit of pRBC (500 ml)
- Symptoms
- See Anemia
- Fatigue
- Dyspnea
- Labs: Acute Anemia with Markedly Decreasing Hemoglobin
- Complete Blood Count
- Lactate Dehydrogenase (Hemolysis)
- Type and Screen (ABO and Rh)
- Labs: Gradually Decreasing of Chronic Anemia
- Complete Blood Count
- Serum Iron, Ferritin, and Total Iron Binding Capacity
- Reticulocyte Count
- Serum Vitamin B12
- Evaluation: Acute Anemia with Markedly Decreasing Hemoglobin
- Identify source of bleeding
- Bedside Ultrasound (e.g. FAST Exam) for Hemothorax or intraabdominal Hemorrhage signs
- Evaluate stool for Gastrointestinal Bleeding (e.g. Stress Ulcer)
- Management
- Treat underlying cause if found
- Treat Hemorrhagic Shock if present
- Conservative transfusion strategy (if hemodynamically stable)
- Approximately 12% of post-ICU patients require transfusion (in other studies, up to 50% received transfusions)
- Marque (2006) Crit Care 10(5):R129 [PubMed]
- Avoid Blood Transfusion if hemodynamically stable and above Hemoglobin target
- See Transfusion Complications
- Blood Transfusion Indications (Hemoglobin targets)
- Hemoglobin <7 mg/dl: Most patients
- Hemoglobin <8 mg/dl: Active Myocardial Ischemia or post-CABG
- Transfusion protocol
- Transfuse one unit at a time and reassess (avoids volume overload and over-correction)
- Prevention
- Reduce blood lost through laboratory blood draws
- Avoid unnecessary blood draws
- Reinject the 5 ml of blood typically discarded with each venous catheter blood draw
- Gastric Ulcer Prophylaxis
- See Gastric Ulcer Prevention in Patients with Critically Illness
- References
- Internet Book of Critical Care (Farkas, EM-Crit)
- https://emcrit.org/ibcc/guide/
- Marino (2014) The ICU Book, p. 349-68
- Vincent (2002) JAMA 288(12):1499-507 [PubMed]