Hemoglobin concentration variations over time in general medical inpatients.
J Hosp Med. 2010 Jun 9;5(5):283-288
Authors: Agustin L, Nicolas C, Sebastian M, Marina H, Abel N, Fernando P, Matias M, Dardo R
BACKGROUND:: A decrease in hemoglobin concentration [Hb] with no apparent cause is frequently observed in critically ill patients. Scarce information is available about this situation in general ward-admitted patients (GWAP). OBJECTIVES:: To describe [Hb] variation with no obvious cause in GWAP, and to estimate the prevalence and predictors of patients with [Hb] decreases >/=1.5 g/dL. DESIGN, SETTING AND PATIENTS:: Prospective, observational study in internal medicine GWAP, carried out at two teaching hospitals in Buenos Aires, Argentina. Patients with a history of, or admitted for diseases associated with decreases in [Hb], as well as those with length of stay less than three days, were excluded. MEASUREMENTS:: Upon hospitalization, complete personal and clinical data were recorded. Furthermore, Katz index, APACHE II acute physiology score (APS) and Charlson score were calculated. [Hb] and hematocrit (HCT) were also assessed during hospitalization. RESULTS:: A total of 338 patients were evaluated, 131 were included. A mean [Hb] decrease of 0.71 g/dL was observed between admission and discharge (P < 0.001; 95% CI, 0.47-0.97). Forty-five percent of the included patients had decreases in [Hb] >/= 1.5 g/dL. This was associated with a higher APS, a higher [Hb] at admission, and a discharge diagnosis of infectious or gastrointestinal disease. No bleeding episodes were observed. CONCLUSIONS:: An [Hb] decrease was frequently observed during GWAP hospitalization with no evident blood loss. Even though this decrease has multiple causes, the severity of the acute illness seems to play a major role. Journal of Hospital Medicine 2010;5:283-288. (c) 2010 Society of Hospital Medicine.
PMID: 20533576 [PubMed - as supplied by publisher]