Anaemia in ICU patient. Vampirism in critical care. Unnecessary bloodletting draws. Iatrogenic anaemia. Secondary anaemia. Do not do recommendations to avoid unnecessary analytics

1. Vampirism in the Intensive Care Unit:
A routine practice?
A.M. Ayuso-Alvarez1
, J.A. García Erce2
, S. Gómez-Ramírez3
, A. Sarria4
, M.
Muñoz3
, M. Quintana Díaz1,5
1
Intensive Medicine Service, University Hospital La Paz, Madrid; 2
Blood and Tissue
Bank of Navarra, Pamplona; 3
Perioperative Transfusion Medicine, University of
Málaga, Málaga; 4
National Health School, University of Alcalá (REDISSEC), Alcalá de
Henares; 5
Department of Medicine, Autonomous University, Madrid (Spain).

2. NO INTEREST CONFLICT
Asesor externo
- AMGEN Oncología 2010/2012
- Roche Anemia 2009
- Ditassa-Ferrer 2004
Charlas, estudios investigación y ayudas a congresos
-Vifor-Uriach/Ferralinze/AMGEN
-Janssen-Cilag/Braun/Celgene/Alexion
-Astra-Tech de Aztra Zeneca/Well-Health?/GSK
-Sanofi Aventis/Esteve/Novartis/Octapharma
-Cobe-Caridian/Roche Oncología/AMGEN Oncologia
Miembro del CAT 2002-2005
Miembro del Documento de Sevilla “Alternativas a la Transfusión”
Miembro del Documento Latino Americano de la Anemia
Miembro de GIEMSA/ Secretario AWGE/Socio SETS/AEHH/NATA
Editor Asociado Revista ANEMIA www.revistaanemia.org
Miembro Comité Científico NATA y TATM
Representante de la SEHH en la ONT
Colaborador del Choosing Wisely en Anestesiología
Vampirism in the Intensive Care Unit:
A routine practice?

3. Vampirism in the Intensive Care Unit:
A routine practice?

4. Anaemia, blood loss & transfusion
Prof Muñoz
Vampirism in the Intensive Care Unit:
A routine practice?

5. NEJM 1986

6. NEJM 1986
Vampirism in the Intensive Care Unit:
A routine practice?

7. JAMA 2002; 288:1499-1507
Vampirism in the Intensive Care Unit:
A routine practice?

8. Vampirism in the Intensive Care Unit:
A routine practice?

9. http://www.choosingwisely.org/doctor-patient-lists/
Five Recommendations from the Italian Federation of Associations of Hospital
Internal Medicine (FADOI) - 1st List (2014)
http://www.choosingwiselyitaly.org/PDF/ENGracc/Scheda%20FADOI%20(1)%20english.pdf
4. Don’t repeat chemistry testing in the face of clinical and laboratory stability
2012
Vampirism in the Intensive Care Unit:
A routine practice?

10. 2014
Vampirism in the Intensive Care Unit:
A routine practice?

11. Objectives
Vampirism in the Intensive Care Unit:
A routine practice?
To evaluate the prevalence and factors
associated with of Hospital Acquired Anaemia
in patients admitted to Intensive Care Units
(ICU).

12. Methods.
Prospective, cross-sectional observational study performed at 5
Spanish hospitals during a 4-month period.
•Data were collected in successive week-days for 7 weeks.
•All patients with ICU <28 days and >24 hours on the day of assessment were
included.
•Variables:
– Clinical and demographic data,
– Phlebotomies (“drawn”) (number and volume),
– Hb change from admission to discharge (DHb), and
– Red blood cell transfusion (RBCT) requirements were collected.
•Data are mean and SD or 95%CI, or number (percentage).
•Student’s t test, Pearson’s χ2
test and lineal regression were performed.
Vampirism in the Intensive Care Unit:
A routine practice?

13. Results.
Overall, 561 patients (66% male) were included.
Mean age was 58 years;
Mean SOFA at admission 5.7± 0.1
APACHE II score at 24 hours 18.3 ± 0.3.
Mean length of ICU stay was 21 days (95%CI: 19-22 days);
ICU mortality rate 12%.
Most frequent reasons for ICU admission were: neurologic (24%),
respiratory (12%), infectious (12%), or cardiovascular diseases
(10%).
Vampirism in the Intensive Care Unit:
A routine practice?

14. Results.
No anemia Mild
anemia
Moderate
anemia
Severe
anaemia
All
patients
p
Patients, n 196 213 118 34 561 ---
Admission Hb (g/dL) 14.2 11.2 9.3 6.9 11.5 <0.001
Phlebotomy (mL/day) 31 33 30 32 31 0.468
Surgery, n (%) 66 (34) 88 (41) 47 (40) 9 (27) 244 (38) 0.212
Transfusion, n (%) 42 (21) 85 (40) 69 (58) 30 (88) 260 (40) <0.001
RBCT (units/patient) 1.6 1.6 3.0 5.2 2.1 <0.001
ICU stay (days) 21 21 20 22 21 0.916
Discharge Hb (g/dL) 10.5 9.3 8.1 9.0 9.4 <0.001
D Hb (g/dL) -3.0 -1.5 0.1 2.1 -1.5 <0.001
Vampirism in the Intensive Care Unit:
A routine practice?

15. Results: Anaemia at Admission
p<0.001
Vampirism in the Intensive Care Unit:
A routine practice?

16. Results: Anaemia evolution
Vampirism in the Intensive Care Unit:
A routine practice?

17. Results: Relationship Hb discharge and stay at ICU
p<0.001
Vampirism in the Intensive Care Unit:
A routine practice?

18. Results.
Total extracted vol
Admission-Discharge
Hb Difference
Hb ICU discharge
RCC Transfused (n)
Vampirism in the Intensive Care Unit:
A routine practice?
PEARSON´S BILATERAL CORRELATION

19. Results.
Adjusting for Hb at admission, a linear relationship between the extracted
volume / day and the Hb at the discharge (R2 = 0.25, p <0.001) was observed
and on the day of the cut (R2 = 0.43, p <0.001).
Discharged Hb
level
Admission-Discharge Hb
difference
R p R p
ICU admission Hb 0,33 <0,001 -0,67 <0,001
Total extracted mL -0,01 0,007 -0,01 0,007
RCC Transfused (n) -0,022 0,160 -0,022 0,160
With no significant relationship to the number of transfused concentrates.
Vampirism in the Intensive Care Unit:
A routine practice?
PEARSON´S MULTILATERAL CORRELATION

21. Conclusions.
A significant number of phlebotomies are performed among ICU
patients, which associated with the development/maintenance of
"acquired anemia."
Although 40% require RBCT, it seems to be effective at controlling
Hb level only in those with severe anemia at ICU admission.
Vampirism in the Intensive Care Unit:
A routine practice?
Frietz 2014

22. Vampirism in the Intensive Care Unit:
A routine practice?
EPIGRAPH
“All great work is the fruit of patience
and perseverance, combined with
tenacious concentration on a subject
over a period of months or years”
Dr Santiago Ramón y Cajal
Navarra-Aragón
Medicine´s Nobel Prize
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