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Nearly two-thirds of intensive care unit patients experienced significant declines in hemoglobin levels during hospitalization, and those patients spent substantially longer in intensive care, according to a new study published in the American Journal of Critical Care.
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Researchers at a southwest Florida hospital found that 64% of ICU patients experienced hospital-acquired anemia (HAA), defined in the study as a decline of at least 10% in hemoglobin levels during their ICU stay.
Patients with HAA spent an average of 5.9 days in intensive care, compared with 3.3 days for those without the condition.
The findings highlight a potentially preventable complication of critical care, and they point to opportunities for nurses to reduce unnecessary blood loss through evidence-based conservation practices.
More Than Half of ICU Patients Entered With Anemia
The study, conducted at Lee Memorial Hospital in Fort Myers, Florida, examined medical records from patients admitted to the ICU between January and June 2024.
Researchers initially reviewed records from 151 patients. After excluding those who received packed red blood cell transfusions or lacked laboratory values needed for comparison, the final analysis included 108 patients.
More than half of the patients (55%) already met the American Society of Hematology’s criteria for anemia when they entered the ICU.
Among the 49 patients who were not anemic at admission, 55% developed hemoglobin levels below those thresholds during their ICU stay.
Overall, 64% of patients experienced a hemoglobin decline of at least 10%, meeting the researchers’ definition of hospital-acquired anemia. Patients who did not meet that definition had an average hemoglobin decline of 4%.
These findings show that significant hemoglobin loss can occur during intensive care, even in patients who enter the ICU without anemia.
Hospital-Acquired Anemia Linked to Longer ICU Stays
Across the study population, the average ICU stay was 4.9 days. Patients who developed HAA, however, remained in intensive care for an average of 2.6 days longer than those who did not.
Researchers also examined whether unusually long ICU stays influenced the results.
After excluding six patients with exceptionally long ICU stays and hemoglobin declines exceeding 40%, the difference remained statistically significant. Patients with HAA spent an average of 5.1 days in the ICU, compared with 2.8 days for those without the condition.
Although the findings show an association between declining hemoglobin levels and longer ICU stays, the study does not establish that anemia caused the extended hospitalizations.
How Routine ICU Care Can Contribute to Blood Loss
Hospital-acquired anemia can develop for several reasons, including blood loss associated with trauma, medical procedures, and repeated blood draws for laboratory testing.
Critically ill patients frequently require blood testing to monitor their condition and guide treatment decisions. Although these tests are essential, the cumulative blood loss from repeated sampling can contribute to declining hemoglobin levels.
The researchers identified several strategies nursing teams can use to help conserve blood, including smaller-volume collection tubes, closed blood sampling systems, and fluid stewardship to help prevent hemodilution, which occurs when excess fluid dilutes the concentration of hemoglobin in the blood.
These strategies offer opportunities to reduce avoidable blood loss without compromising necessary patient monitoring.
Nurses Can Lead Blood Conservation Efforts
Darnella Adams, DNP, MSN, RN, PCCN, a clinical nurse and chair of Lee Memorial Hospital’s Nursing Research and Evidence-Based Practice Council, emphasized the importance of recognizing hospital-acquired anemia as a patient safety concern.
“Hospital-acquired anemia is a serious, often overlooked threat that directly drives up ICU length of stay, morbidity and mortality,” she said. “Drop by drop, vial by vial, nurses can lead blood-conservation initiatives, reduce the incidence of anemia and improve patient outcomes.”
Because the research was conducted at a single hospital and included 108 patients, additional studies are needed to determine whether the findings apply to other ICU populations.
For critical care nurses, these findings reinforce the value of evaluating blood collection practices and identifying opportunities to minimize avoidable blood loss.
