Increase in Rates of Post-Hospitalization Iron-Deficiency Anemia
The long-term outcomes of limiting the frequency of red blood cell transfusions in patients with anemia had not previously been described.
Post-hospitalization iron-deficiency anemia increased in parallel with decreased red blood cell (RBC) transfusion, according to study results published in the Annals of Internal Medicine. The study assessed the prevalence of anemia and the characteristics of associated morbidity and mortality within 6 months of hospital discharge.
Moderate anemia, which is independently associated with short- and long-term morbidity and mortality and common in hospitalized patients, was traditionally treated with allogeneic RBC transfusions to increase hemoglobin. Results from multiple randomized clinical trials later indicated that less frequent transfusions yielded similar efficacy while decreasing potential infectious, cardiopulmonary, and immunomodulatory complications, but the long-term outcomes of decreased RBC transfusions had not been described.
In this retrospective cohort study, researchers assessed data from 445,371 surviving adults who experienced 801,261 hospitalizations at 21 hospitals between January 2010 and December 2014.
The prevalence of moderate anemia, defined as hemoglobin levels between 7 and 10 g/dL, at hospital discharge increased from 20% in 2010 to 25% in 2014 (P <.001). The adjusted 6-month mortality rate in patients with moderate anemia decreased from 16.1% to 15.6% (P =.004). During that time, RBC transfusions decreased by 28% (P <.001).
The percentage of patients whose anemia had resolved within 6 months of hospital discharge decreased by 8%, from 42% in 2010 to 34% in 2014 (P <.001). At the same time, RBC transfusions within 6 months of hospital discharge decreased from 19% to 17% (P <.001), and rehospitalization within 6 months of hospital discharge decreased from 37% to 33% (P <.001).
The authors concluded that “these data support the efficacy and safety of [limiting] RBC transfusion in patients with anemia during and after hospitalization” and suggested that future studies should focus on alternative therapies for anemia.
1. Roubinian NH, Murphy EL, Mark DG, et al. Long-term outcomes among patients discharged from the hospital with moderate anemia: a retrospective cohort study [published online December 18, 2018]. Ann Intern Med. doi:10.7326/M17-3253