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What is a relatively new condition called HAA that can develop in the hospital?

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asked May 9, 2012 in Site Q&A by jlvarisco (2,070 points)
recategorized Jun 4, 2012 by LarryEitel

3 Answers

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A new study has found that if hospitals draw too much blood for diagnostic testing from patients admitted for heart attacks, they place those patients at risk for hospital-acquired anemia (HAA) and increased chance of complications and death.
 

People with anemia have a shortage of healthy red blood cells that carry oxygen. Anemia can be a chronic condition caused by problems with bone marrow, a nutritional deficiency or other medical condition. Some hospital patients can develop a sudden hospital-acquired anemia or HAA. Blood loss is a known cause of HAA and hospitals already take precautions to limit blood loss from bleeding. However, HAA commonly occurs in hospital patients who have not suffered any bleeding.
 

Researchers in this study set out to determine if phlebotomy, or the taking of blood for testing, could be linked to hospital-acquired anemia. If so, hospitals could develop protocols to reduce the amount of blood taken for testing and therefore prevent HAA.
 

They studied medical records for nearly 18,000 patients admitted for acute myocardial infarction (AMI) at 57 hospitals across the United States who were not anemic when admitted. They found that 1 in 5 of those patients developed moderate to severe hospital-acquired anemia during their hospital stay.
 

Heart attack patients who develop hospital-acquired anemia actually feel worse and have a higher rate of mortality than those without HAA.
 

The researchers then calculated the amount of blood taken for diagnostic testing, called diagnostic blood loss (DBL), finding that patients who developed hospital-acquired anemia had a higher DBL than those without HAA. The average amount of DBL was equivalent to half of a unit of whole blood. The study also showed that average amounts of DBL varied widely between hospitals, suggesting that some hospitals took blood to run “routine” tests that may have been unnecessary.
 

“Our findings are likely generalizable to other populations of seriously ill medical patients,” researchers said. “In this regard, further studies that establish whether minimizing DBL can prevent HAA and improve patient outcomes could have broad implications for hospitalized patients.”
 

To prevent unnecessary diagnostic blood loss, study researchers recommended the use of smaller pediatric tubes for blood collection or filling standard adult tubes with less blood in addition to determining if certain blood tests are necessary.

The study entitled “Diagnostic Blood Loss from Phlebotomy and Hospital-Acquired Anemia during Acute Myocardial Infarction” appears in the current issue of Archives of Internal Medicine.
 

“With the increasing evidence that health care system interventions can reduce or prevent many hospital-acquired complications, efforts to implement effective strategies to make medical care safer and more effective are crucial,” said Stephanie Rennke, MD and Margaret C. Fang, MD, MPH in a commentary. “As [researchers] highlight in their study, HAA could potentially be considered a hazard of hospitalization. Investigations on how to modify this risk (eg, through reducing unnecessary phlebotomy or reducing the volume of blood obtained during a hospitalization) could provide important insights into how to reduce anemia in the hospital and improve the value and appropriateness of care.”
 

by Paul Napoli August 10, 2011

 

http://newyorkcity.injuryboard.com/medical-malpractice/too-much-blood-taken-for-hospital-tests-can-cause-anemia-increasing-risk-of-complications-and-death.aspx?googleid=293030

 

 

 

 
answered May 9, 2012 by Connie Barnes (240 points)
edited May 10, 2012 by Jan B. Wade
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We used to call this nosocomial acquired anemia, but is better communicated as Hospital Acquired Anemia.  A better known term is nosocomial infection now called hospital acquired infection.

nos·o·co·mi·al  (nimagesimageimage-kimageimagemimage-imagel)adj.

1. Of or relating to a hospital.

2. Of or being a secondary disorder associated with being treated in a hospital but unrelated to the patient's primary condition

 

Here's another article.  To show how old this condition is, this article is from 1973.  Those of us working at blood management programs set up protocols to keep this from happening. 

 

Nosocomial Anemia

  1. Elaine Eyster, MD;
  2. James Bernene, MD

 

Abstract

Blood loss was measured and serial hematocrit readings and reticulocyte counts were performed on 93 consecutive patients. The mean daily blood loss of 54 ml was accompanied by an observed reticulocyte count of 3.4% over an average of 8.2 days. Hematocrit values in 75 patients with no evidence of bleeding decreased 5.7% during the 20.9 days of hospitalization. Of the 64 patients not anemic at the time of admission, 26 (40%) became anemic with no obvious cause prior to discharge from the hospital. Bloodletting for diagnostic studies is a significant cause of anemia and reticulocytosis in hospitalized patients.

 

answered May 9, 2012 by Jan B. Wade (4,930 points)
edited May 12, 2012 by Jan B. Wade
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Here is another report on hospital caused anemia.

 

Blood Loss From Hospital Tests May Cause Anemia in Patients, Study Finds



Patients who enter hospitals due to heart attacks may be leaving with anemia caused by laboratory tests that draw too much blood, raising their risk of declining health and death, a study found.
 

In an analysis of almost 18,000 patients in 57 U.S. hospitals from 2000 to 2008, researchers found that 20 percent of patients who didn’t have anemia when admitted for heart attacks developed moderate to severe cases of the red blood-cell deficiency by the time they left. The study is published today in the journal Archives of Internal Medicine.
 

Anemia is associated with greater death rates and worse health in patients who have already suffered heart attacks, the study said. Patients who developed anemia left the hospital suffering from fatigue, shortness of breath and physical weakness. Doctors may need to change some of their practices, said Mikhail Kosiborod, an associate professor of medicine at the University of Missouri-Kansas City and the study’s senior author.
 

“The amount of blood we take from patients is a major risk factor” for anemia, Kosiborod said. “If they have other medical problems their body can’t regenerate blood cells fast enough.”
 

Preventable adverse events in hospitals such as infections and sickness cost $4.4 billion a year, and happen to 1 in 7 beneficiaries of Medicare, the U.S. health program for the elderly and disabled, according to the Department of Health and Human Services. Kosiborod said the findings weren’t related to medical mistakes, though steps may be taken to reduce the amount of blood drawn.
 

Blood Volumes
 

The study found that the average volume of blood drawn from patients who developed anemia was 173.8 milliliters. That’s more than double the 83.5 milliliters from patients who didn’t get anemia, according to the study. For every 50 milliliters of blood drawn, the risk of moderate to severe hospital-acquired anemia increased by 18 percent.
 

Many doctors have become accustomed to drawing blood without an immediate need for the sample, said Stephanie Rennke, an assistant clinical professor at the University of California, San Francisco and lead author of a commentary article on the anemia study.
 

“Some doctors indiscriminately take blood tests without consciously asking why they need it and what they’re looking for,” she said in an interview. “It’s hard to change when they get into the routine of doing things.”
 

She said facilities can prevent hospital-acquired anemia by providing proper nutrition to patients, testing from a single blood sample each day and only testing on the day of discharge if absolutely necessary.
 

The average blood loss across hospitals ranged from 119 to 246 milliliters, indicating that some blood loss could be prevented by eliminating routine testing, the study’s authors said.
 

By using smaller tubes and sampling from blood that has already been drawn, hospitals may be able to reduce the amount of blood loss, Kosiborod said.
 

“Doctors have to take blood to help patients,” he said.

answered May 9, 2012 by Jan B. Wade (4,930 points)
edited May 12, 2012 by Jan B. Wade

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