Anemia in Critically Ill Patients; Prevalence and Prognostic Implications

Abstract Background: Anemia is a commonly encountered clinical problem in the critically ill. Ninety-five percent of critically ill patients who stay in the Intensive Care Unit (ICU) for 72 hours or greater suffer from anemia and approximately 40% of them receive Packed Red Blood Cell (PRBC) transfusions. In 2001, nearly 14 million units of packed red blood cells were transfused, but the physiologic basis for transfusion in the critically ill is not without controversy. In the last two decades transfusion practices have become more restrictive likely in response to prospective research. Aim of Study: The aim of this work is to evaluate the prevalence of anemia in critically ill patients and to assess the effect of anemia of critical illness on the patients' outcome. Patients and Methods: The study was conducted from the existing data base in the Critical Care Department of Elsahel Teaching Hospital from January 2015 to December 2018. The collected data focused on fulfilling the following measures on the selected patients: Comparison of age, length of ICU stays of the patients and APACHE II score in survivors and non survivors groups, frequency of blood transfusion and iron supplementation in the management of anemia of critical illness and its association with the outcome, the relation of follow-up complete blood count and the outcome. Results: In this retrospective cohort study involving 165 patients 74 males and 91 females with mean age 55. 13±20.72, and mean length of stay 11, 87±12,04. The survivors were 103 (62.5%), and those who not survive were 62 (37.5%) the mean hemoglobin at admission was 8.28g dl–1 (±1.96) for survivors group and 8.27 (±2.36) for non survivors. reasons of admission which were associated with higher frequency of mortality among the others are post cardiac arrest, respiratory failure, neurologic problems, cardiogenic shock, septic shock, acute renal failure and obstetrics catastrophes with frequency (85.7%, 77.8%, 66.7%, 60%, 55%, 45.5%, 60%) respectively. Regarding blood transfusion as in management of anemia, in this study there were no significant difference in relation of blood transfusion and the outcome (our hemoglobin threshold was 7g/dl). In this study we had 78 patients admitted for more than fourteen days in the ICU they represent 25% of our study group 39.7% of them died with hemoglobind 7g/dl which was chosen as a best predictor to outcome. Conclusion: It was found that there is no association between management of anemia (blood transfusion and iron supplementation) and the outcome of the patient and that patient's hemoglobin at the end of ICU stay is of good prog-nostic value of anemic patients.