scholarly journals Red Blood Cell Transfusion and the Use of Intravenous Iron in Iron Deficient Patients Presenting to the Emergency Department

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 1-2
Author(s):  
Arvand Barghi ◽  
Robert Balshaw ◽  
Emily Rimmer ◽  
Murdoch Leeies ◽  
Allan Garland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Iron Deficiency ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Hemoglobin Concentration ◽  
Factors Associated ◽  
Iv Iron ◽  
Iron Parameters ◽  
Rbc Transfusion

Background: Red blood cell (RBC) transfusions are often used to treat patients with iron deficiency who present to the emergency department (ED) with symptomatic anemia. Intravenous (IV) iron is the preferred treatment in this setting, as it has been shown to increase hemoglobin concentration rapidly and durably. We aim to determine the incidence of iron deficiency anemia (IDA) and the management of these patients in the ED setting. Objectives: To evaluate the incidence of IDA, the frequency of RBC transfusion and iron supplementation, and factors associated with RBC transfusion. Study Design: Retrospective cohort study of all adult patients presenting to the St Boniface Hospital (Winnipeg, CAN) ED from January 2014 to January 2019. Methods: We used electronic data from the Emergency Department Information System (EDIS) and Laboratory Information Services (LIS) databases to identify patients presenting with IDA, defined as anemia (hemoglobin <120 g/L) with either a transferrin saturation less than 20% or ferritin less than 30 umol/L, or mean corpuscular volume (MCV) of < 75 fL. A ferritin greater than 100 umol was used to exclude IDA, regardless of MCV. We extracted patient demographics, diagnoses, markers of iron storage, RBC transfusion and use of IV iron. Multivariate logistic regression analysis was used to evaluate factors associated with RBC transfusion. Results: Of 39222 patients, 17945 (45%) were anemic. Of the anemic patients, iron parameters were ordered in 1848 (10.3%) patients, and IDA was present in 910 (5.1 %). In the IDA population, 95 patients (10.4 %) received 1 RBC unit, and 197 patients (21.6 %) received 2 or more units. Oral iron and IV iron were prescribed for 64 (7 %) and 14 (1.5 %) patients, respectively. Our logistic regression model demonstrated that hemoglobin concentration was the main determinant of whether patients received RBC transfusion. Other variables including patient age, cardiac symptoms, heart rate, blood pressure, and CTAS score were not associated with increased likelihood of receiving RBC transfusion. Conclusion: Iron parameters were infrequently ordered in the evaluation of anemia in the ED, with limited use of oral and IV iron. The decision to transfuse RBCs was primarily influenced by hemoglobin concentration, but not other surrogates of hemodynamic instability. An interventional study to improve education and access to oral and IV iron is planned to reduce unnecessary RBC transfusions and their associated risks in patients with IDA. Disclosures No relevant conflicts of interest to declare.

scholarly journals Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2475
Author(s):  
Olivier Peyrony ◽  
Danaé Gamelon ◽  
Romain Brune ◽  
Anthony Chauvin ◽  
Daniel Aiham Ghazali ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Cross Sectional Study ◽  
Red Blood Cell Transfusion ◽  
Cross Sectional ◽  
Acute Bleeding ◽  
History Of ◽  
Rbc Transfusion

Background: We aimed to describe red blood cell (RBC) transfusions in the emergency department (ED) with a particular focus on the hemoglobin (Hb) level thresholds that are used in this setting. Methods: This was a cross-sectional study of 12 EDs including all adult patients that received RBC transfusion in January and February 2018. Descriptive statistics were reported. Logistic regression was performed to assess variables that were independently associated with a pre-transfusion Hb level ≥ 8 g/dL. Results: During the study period, 529 patients received RBC transfusion. The median age was 74 (59–85) years. The patients had a history of cancer or hematological disease in 185 (35.2%) cases. Acute bleeding was observed in the ED for 242 (44.7%) patients, among which 145 (59.9%) were gastrointestinal. Anemia was chronic in 191 (40.2%) cases, mostly due to vitamin or iron deficiency or to malignancy with transfusion support. Pre-transfusion Hb level was 6.9 (6.0–7.8) g/dL. The transfusion motive was not notified in the medical chart in 206 (38.9%) cases. In the multivariable logistic regression, variables that were associated with a higher pre-transfusion Hb level (≥8 g/dL) were a history of coronary artery disease (OR: 2.09; 95% CI: 1.29–3.41), the presence of acute bleeding (OR: 2.44; 95% CI: 1.53–3.94), and older age (OR: 1.02/year; 95% CI: 1.01–1.04). Conclusion: RBC transfusion in the ED was an everyday concern and involved patients with heterogeneous medical situations and severity. Pre-transfusion Hb level was rather restrictive. Almost half of transfusions were provided because of acute bleeding which was associated with a higher Hb threshold.

scholarly journals Iron deficiency anemia in the emergency department: over-utilization of red blood cell transfusion and infrequent use of iron supplementation

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 167-174 ◽  
Author(s):  
Jordan Spradbrow ◽  
Yulia Lin ◽  
Dominick Shelton ◽  
Jeannie Callum
Keyword(s):  
Emergency Department ◽  
Iron Deficiency ◽  
Blood Cell ◽  
Iron Deficiency Anemia ◽  
Red Blood Cell ◽  
Iron Supplementation ◽  
Oral Iron ◽  
Deficiency Anemia ◽  
Tertiary Center ◽  
Rbc Transfusion

AbstractObjectivesThree are no clinical practice guidelines that specifically address the management of patients with iron deficiency anemia (IDA) in the emergency department (ED). The goal of this study was to describe the characteristics of IDA patients who present to the ED, documentation of IDA by emergency physicians, utilization of iron supplementation, and the appropriateness of red blood cell (RBC) transfusions ordered in the ED.MethodsA retrospective medical chart review was performed of IDA patients who visited the ED of a large tertiary center over a three-month period. Appropriateness of RBC transfusion was determined using a novel algorithm developed by our institution.ResultsOver the study period, there was a 0.3% (49/14,394) prevalence of IDA in the ED. In thirty (30/49; 61%) patients, IDA was documented by an emergency physician. RBC transfusions were administered to 19 patients; 10 transfusions (53%) were appropriate, 3 (16%) were appropriate for indication, but more than the required number of units were ordered, and 6 (32%) were inappropriate. Of the patients discharged, one (1/25; 4%) patient received intravenous iron in the ED and 6 of the 11 patients (55%) that were not already taking oral iron received a prescription at discharge from the ED.ConclusionsThis assessment demonstrated that management of IDA patients presenting to the ED may represent an important knowledge-to-practice gap. It revealed that RBC transfusion may be over-utilized and could be replaced by safer, lower-cost alternatives such as intravenous and oral iron. Guidelines for management of IDA in the ED may be necessary to achieve consistent IDA management and avoid inappropriate use of RBC transfusion.

scholarly journals Delirium Tremens in Psychiatric Ward at Songklanagarind Hospital

2018 ◽  
Vol 36 (3) ◽  
pp. 213
Author(s):  
Teerapat Teetharatkul ◽  
Arnont Vittayanont
Keyword(s):  
Logistic Regression ◽  
Blood Cell ◽  
Cell Count ◽  
Red Blood Cell ◽  
Delirium Tremens ◽  
Psychiatric Ward ◽  
P Value ◽  
Blood Cell Count ◽  
Factors Associated ◽  
Red Blood Cell Count

Objectives: To examine the epidemiology of delirium tremens patients in the psychiatric ward at SongklanagarindHospital and to find factors associated with the disease.Material and Methods: This was a cross-sectional study that collected data from alcohol dependent patients who were admitted in the psychiatric ward at Songklanagarind Hospital between January 2011 and December 2014. Descriptive statistics were used to analyze the data and logistic regression analysis used to analyze factors associated with the disease.Results: The prevalence of delirium tremens in psychiatric ward was 28.0%. The study found that body temperature >37.8 °C (p-value=0.026), eosinophils >6.0% (p-value=0.046), hematocrit <40.0% (p-value<0.001), red blood cells <4.5x106/ul (p-value<0.001), MCV <83 or >97 g/dl (p-value<0.001), MCH <27 or >33 pg (p-value<0.001), platelets <150x103/ul (p-value<0.001), magnesium <16 mg/dl (p-value=0.043), zinc <0.7 mg/dl) (p-value=0.029), total bilirubin >1 mg/dl (p-value= 0.039) and direct bilirubin >0.2 mg/dl (p-value=0.036) were significant factors correlated with delirium tremens. Multiple logistic regression models found that only red blood cell count <4.5x106/ul (p-value<0.001) was a significant factor correlated with delirium tremens.Conclusions: The prevalence of delirium tremens in this study was lower than in other Asian countries. Red blood cell count <4.5x106/ul (p-value<0.001) was correlated with delirium tremens.

scholarly journals Simultaneous measurement of reticulocyte and red blood cell indices in healthy subjects and patients with microcytic and macrocytic anemia

Blood ◽  
1995 ◽  
Vol 85 (3) ◽  
pp. 818-823 ◽  
Author(s):  
G d'Onofrio ◽  
R Chirillo ◽  
G Zini ◽  
G Caenaro ◽  
M Tommasi ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Marrow Transplantation ◽  
Healthy Subjects ◽  
Megaloblastic Anemia ◽  
Macrocytic Anemia ◽  
Hemoglobin Concentration ◽  
Beta Thalassemia ◽  
Hemoglobin Content

Using the new Bayer H*3 hematology analyzer (Leverkusen, Germany), we have determined red blood cell and reticulocyte indices in 64 healthy subjects, in patients with microcytosis due to iron deficiency (58 patients) and heterozygous beta-thalassemia (40 patients), and in patients with macrocytosis (28 patients). We found in all cases that reticulocytes were larger than mature red cells by 24% to 35%, with a hemoglobin concentration 16% to 25% lower and a similar hemoglobin content. The correlation between red cell and reticulocyte indices was strikingly tight (r = .928 for volume, r = .929 for hemoglobin concentration, r = .972 for hemoglobin content) in all four groups, regardless of red blood cell size. The ratio of reticulocyte to red blood cell mean corpuscolar volume (MCV ratio) was constantly above 1. Inversion of the MCV ratio was observed only in four patients. It was always abrupt and transitory and was associated with erythropoietic changes leading to the production of red blood cells of a different volume (treatment of megaloblastic anemia, functional iron deficiency, bone marrow transplantation). In two cases of marrow transplantation, reticulocyte volume fell during the aplastic phase after conditioning chemotherapy and then rapidly increased up to values higher than before; this production of macroreticulocytes was the earliest sign of engraftment.

scholarly journals Cardiorespiratory monitoring of red blood cell transfusions in preterm infants

2021 ◽  
Author(s):  
Jarinda A. Poppe ◽  
Tanja van Essen ◽  
Willem van Weteringen ◽  
Sten P. Willemsen ◽  
Irwin K. M. Reiss ◽  
...  
Keyword(s):  
Blood Cell ◽  
Preterm Infants ◽  
Red Blood Cell ◽  
Hemoglobin Concentration ◽  
Repeated Measurements ◽  
Before And After ◽  
Red Blood Cell Transfusions ◽  
Monitor Data ◽  
Preterm Newborns ◽  
Rbc Transfusion

AbstractClinical improvement after red blood cell (RBC) transfusions in preterm infants remains debated. This study aims to investigate the effect of RBC transfusion on the occurrence of desaturations and hypoxia, and other cardiorespiratory outcomes in preterm infants. In this longitudinal observational study, prospectively stored cardiorespiratory parameters of preterm infants who received at least one RBC transfusion between July 2016 and June 2017 were retrospectively analyzed. Sixty infants with 112 RBC transfusions, median GA of 26.7 weeks, were included. The number of desaturations and area < 80% SpO2 limit, as a measure of the hypoxic burden, were calculated in 24 h before and after RBC transfusion. A mixed effects model was used to account for repeated measurements. Overall, the mean (SE) number of desaturations per hour decreased from 3.28 (0.55) to 2.25 (0.38; p < 0.001), and area < 80% SpO2 limit decreased from 0.14 (0.04) to 0.08 (0.02) %/s (p = 0.02). These outcomes were stratified for the number of desaturations in 24 h prior to RBC transfusion. The largest effect was observed in the group with the highest mean number of desaturations (≥ 6) prior to RBC transfusion, with a decrease from 7.50 (0.66) to 4.26 (0.38) (p < 0.001) in the number of desaturations and 0.46 (0.13) to 0.20 (0.06) in the area < 80% SpO2. Perfusion index increased significantly after RBC transfusion (p < 0.001). No other significant effects of RBC transfusion on cardiorespiratory data were observed.Conclusions: RBC transfusions in preterm newborns could help decrease the incidence of desaturations and the area < 80% SpO2 as a measure of the hypoxic burden. The higher the number of desaturations prior to the RBC transfusion, the larger the effect observed. What is Known:•Red blood cell transfusions potentially prevent hypoxia in anemic preterm infants by increasing the circulatory hemoglobin concentration and improving tissue oxygenation.•There is not a predefined hemoglobin concentration cut-off for the occurrence of symptomatic anemia in preterm infants. What is New:•Oxygen desaturations and hypoxia in anemic preterm infants can be improved by RBC transfusions, especially if more desaturations have occurred before transfusion.•Cardiorespiratory monitor data may help identify infants who will benefit most from red blood cell transfusions.

scholarly journals Epidemiology of Hospitalizations Due to Autoimmune Hemolytic Anemia in the United States

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4150-4150
Author(s):  
Sanjana Mullangi ◽  
Preeti Yadav ◽  
Ekim Kilinc ◽  
Silpa Gudivada ◽  
Javaria Khan ◽  
...  
Keyword(s):  
United States ◽  
Logistic Regression ◽  
Blood Cell ◽  
Hospital Mortality ◽  
Red Blood Cell ◽  
Autoimmune Hemolytic Anemia ◽  
The United States ◽  
Study Cohort ◽  
Factors Associated ◽  
Poor Outcomes

Abstract Introduction: Autoimmune hemolytic anemia (AIHA) is an acquired immune disorder resulting in the production of cold and warm autoantibodies directed against red blood cell antigens; characterized by shortened red blood cell survival and a positive Coombs test. Types include primary disease (idiopathic) or secondary to other autoimmune disorders, malignancies, or infections. Treatment involves immunosuppression with corticosteroids and other agents, Transfusion. There is not much recent data available on epidemiology of AIHA. We aim to estimate epidemiological trends and outcomes of AIHA as well as factors associated with poor outcomes by using the largest available national database from the United States. Methods: We derived a study cohort from the National Inpatient Sample (NIS) for the years 2007-2018 for hospitalizations due to AIHA by using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes ICD-9-CM/ICD-10-CM). Other diagnosis and comorbidities were also identified by ICD-9/10-CM codes and Elixhauser comorbidity software. Our primary outcome was discharge disposition following AIHA hospitalization. We utilized multivariable survey logistic regression models to analyze and identify predictors of poor outcomes. Results: Between 2007-2018, a total of 52,814 hospitalizations occurred due to primary diagnosis of AIHA. Burden of hospitalizations remained stable from 4,254 (8.1%) in 2007 to 4,405 (8.3%) in 2018. AIHA patients in the study cohort were mostly above 65 years of age (48.6%) followed by 35-65 years of age (33.7%), females (58.3%) and Caucasians (69.1%). Overall in-hospital mortality of AIHA hospitalizations was 3.1%, and discharge to facility was 11.86%. Median length of stay for AIHA hospitalization was 4-days (interquartile range: 2-days to 6-days). Furthermore, in multivariable logistic regression analysis, increasing age (OR 1.2; 95%CI 1.1-1.3; p&lt;0.001), male gender (OR 1.5; 95%CI 1.2-1.3; p:0.0024), vascular events (OR 1.5 ; 95%CI 1.1-2.0; p:0.0156), teaching hospitals (OR 3.1; 95%CI 1.5-6.5; p:0.002), plasmapheresis (OR 5.5; 95%CI 2.8-10.8; p:0.001) and intravenous immunoglobulins (OR 1.9; 95%CI 1.3-3.0; p:0.001) were associated with higher in-hospital mortality. Conclusion: Our study describes the epidemiology of hospitalizations due to AIHA in the United States from a nationally representative database. We observed that hospitalization burden due to AIHA have remained stable from 2007 to 2018. We also identified factors associated with higher in-hospital mortality and some of which are modifiable. Further studies are required to establish the causal association of these factors to poor outcomes and develop better risk stratification strategies to improve overall outcomes of AIHA. Disclosures No relevant conflicts of interest to declare.

scholarly journals Red cell distribution width as a predictor for bronchopulmonary dysplasia in premature infants

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hayato Go ◽  
Hitoshi Ohto ◽  
Kenneth E. Nollet ◽  
Kenichi Sato ◽  
Hirotaka Ichikawa ◽  
...  
Keyword(s):  
Blood Cell ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Red Blood Cell ◽  
Area Under The Curve ◽  
Cell Distribution ◽  
Characteristic Analysis ◽  
Distribution Width ◽  
Potential Biomarker ◽  
Rbc Transfusion

AbstractBronchopulmonary dysplasia (BPD) is the most common morbidity complicating preterm birth. Red blood cell distribution width (RDW), a measure of the variation red blood cell size, could reflect oxidative stress and chronic inflammation in many diseases such as cardiovascular, pulmonary, and other diseases. The objectives of the present study were to evaluate perinatal factors affecting RDW and to validate whether RDW could be a potential biomarker for BPD. A total of 176 preterm infants born at < 30 weeks were included in this study. They were categorized into BPD (n = 85) and non-BPD (n = 91) infants. RDW at birth and 14 days and 28 days of life (DOL 14, DOL 28) were measured. Clinical data were obtained from all subjects at Fukushima Medical University (Fukushima, Japan). The mean RDW at birth, DOL 14 and DOL 28 were 16.1%, 18.6%, 20.1%, respectively. Small for gestational age (SGA), chorioamnionitis (CAM), hypertensive disorders of pregnancy (HDP), gestational age and birth weight were significantly associated with RDW at birth. SGA, BPD and red blood cell (RBC) transfusion before DOL 14 were associated with RDW at DOL 14. BPD and RBC transfusion before DOL 14 were associated with RDW at DOL 28. Compared with non-BPD infants, mean RDW at birth DOL 14 (21.1% vs. 17.6%, P < 0.001) and DOL 28 (22.2% vs. 18.2%, P < 0.001) were significantly higher in BPD infants. Multivariate analysis revealed that RDW at DOL 28 was significantly higher in BPD infants (P = 0.001, odds ratio 1.63; 95% CI 1.22–2.19). Receiver operating characteristic analysis for RDW at DOL 28 in infants with and without BPD yielded an area under the curve of 0.87 (95% CI 0.78–0.91, P < 0.001). RDW at DOL 28 with mild BPD (18.3% vs. 21.2%, P < 0.001), moderate BPD (18.3% vs. 21.2%, P < 0.001), and severe BPD (18.3% vs. 23.9%, P < 0.001) were significantly higher than those with non-BPD, respectively. Furthermore, there are significant differences of RDW at DOL 28 between mild, moderate, and severe BPD. In summary, we conclude that RDW at DOL 28 could serve as a biomarker for predicting BPD and its severity. The mechanism by which RDW at DOL 28 is associated with the pathogenesis of BPD needs further elucidation.

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