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• W2088299347 abstract "To the Editor:—Anemia is a common problem among hospitalized elderly patients, but nothing is known about the influence of phlebotomy for diagnostic testing on the hemoglobin level during hospitalization in this population. The total amount of blood withdrawn and the frequency of phlebotomy were noted daily in 114 consecutive elderly (mean 82.5 years, range 65–98) inpatients, admitted to an acute geriatric ward. A hemoglobin (Hb) level was performed upon admission (HbA) and at the time of discharge (HbD). For patients who died, the last available hemoglobin value was taken. Anemia was defined according to the WHO criteria (HB < 13 g/dL for men and < 12 g/dL for women). No information about the study was released which might influence or alter the behavior of junior staff in ordering tests. Sixteen (14%) had 250 mL or more blood removed, of whom two gave more than 500 mL. Each phlebotomy averaged 11.3 mL (SD 9.1), and each patient was phlebotomized an average of 0.8 times (SD 0.65) per day (Table 1). One-hundred and four patients were eligible for further study. In three patients, only one Hb value was available (hospital stay < 72 h), and another seven, all with anemia upon admission, were given transfusion or treated with iron, folate, or vitamin B12. The difference between HbA (mean 12.9 g/dL) and HbD (mean 12.3 g/dL) was statistically significant (Wilcoxon matched pairs test P = 0.0001). There was a weak but significant correlation (Spearman's rs = −0.25; P = 0.015) between the amount of blood loss and the change in Hb level (HbD – HbD). Of the 61 patients not anemic upon admission, 17 (28%) became anemic; 12 of these had an anemia of chronic disorder,1 two had gastrointestinal bleeding for which no specific therapy was needed, and three patients had a mild (Hb > 11.5 g/dL) but unexplained anemia (blood loss of 300, 180, and 80 mL). None of the 104 patients received transfusion. TABLE 1. The measured total and daily blood loss is slightly lower than the results of Smoller and Kruskall2 and Miller3 who observed a mean daily phlebotomy volume of 14.4 to 20.8 mL in adult patients on a medical ward. Patients on intensive care units have a considerably higher amount of blood removed.2,4,5 Diagnostic blood loss influences inversely the Hb level during hospitalization but is not sufficient to cause serious anemia, nor to induce an increasing transfusion need. Nevertheless, caution is warranted in this population, which has an altered hematopoietic response to stress factors such as minute bleeding.6" @default.
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• W2088299347 date "1992-03-01" @default.
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• W2088299347 title "Blood Loss from Diagnostic Laboratory Tests in Elderly Patients" @default.
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• W2088299347 doi "https://doi.org/10.1111/j.1532-5415.1992.tb02091.x" @default.
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