Extracciones de sangre y anemia del paciente crítico

Información del artículo

Resumen

Objetivo

Conocer las variaciones de hemoglobina en pacientes no sangrantes, su posible relación con volumen de sangre extraído y número de extracciones.

Métodos

Estudio observacional y prospectivo realizado desde abril hasta agosto de 2007. Se determinaron los valores de hemoglobina durante la estancia en Unidad de Cuidados Intensivos, volumen extraído en cada analítica, balance hídrico, APACHE II (Acute Physiology and Chronic Health Evaluation II) y otras variables demográficas. Aplicamos análisis descriptivo y de regresión lineal para conocer el comportamiento de estas variables.

Resultados

Se estudiaron 124 pacientes. El 59,7% sufrió una disminución leve de hemoglobina (descenso de hemoglobina ≤ 2g/dl), siendo ésta más grave (pérdida de hemoglobina ≥ 2g/dl) en el 21,8%. Estas disminuciones se correlacionaron con el volumen extraído y el número de flebotomías, r=0,557 (p: ns). No se encontró relación entre balance hídrico y disminución de hemoglobina.

Conclusiones

La anemia en el paciente crítico se relaciona con altos volúmenes de sangre extraída y número de extracciones.

Palabras clave:

Hemoglobina

Anemia

Sangre

Pacientes críticos

Recolección de muestras de sangre

Abstract

Objective

To determine the hemoglobin level variations in non-bleeding patients, its possible relationship with the blood volume drawn and number of extractions.

Methods

An observational, prospective study conducted from April to August 2007. Hemoglobin values during the ICU stay, blood volume drawn in each phlebotomy, fluid balance, APACHE II and other demographic variables were determined.

Results

One hundred and twenty four patients were studied. Of these, 59.7% experienced a mild decrease of hemoglobin levels (< 2g/dl) whereas 21.8% presented a more severe reduction (> 2g/dl). These decreases were correlated with the blood volume withdrawn and number of phlebotomies performed (r= 0.557, p<0.000). There was no significant relationship between fluid balance and decrease in hemoglobin.

Conclusion

Anemia in critical ill patient seems to be related to blood volume drawn and number of phlebotomies.

Keywords:

Hemoglobin

Anemia

Blood

Critically ill patient

Specimen collection

El Texto completo está disponible en PDF

Bibliografía recomendada

[Fowler and Berenson, 2003]

R.A. Fowler, M. Berenson.

Blood conservation in the Intensive Care Unit.

Crit Care Med, 31 (2003), pp. 715-720

[Tinmouth et al., 2008]

A. Tinmouth, L. McInteryre, R. Fowler.

Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients.

Can Med Assoc J, 178 (2008), pp. 49-57

Bibliografía

[1.]

H.L. Corwin, A. Gettinger, R.G. Pearl, M.P. Fink, M.M. Levy, E. Abraham, et al.

The CRIT Study: Anemia and blood transfusion in the critically ill- current clinical practice in the United States.

Crit Care Med, 32 (2004), pp. 39-52

http://dx.doi.org/10.1097/01.CCM.0000104112.34142.79 | Medline

[2.]

J.L. Vincent, J.F. Baron, K. Reinhart, L. Gattinoni, L. Thijs, A. Webb, et al.

Anemia and blood transfusion in critically ill patients.

JAMA, 288 (2002), pp. 1499-1507

Medline

[3.]

C. Chant, G. Wilson, J.O. Friedrich.

Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study.

Crit Care, 10 (2006), pp. R140

http://dx.doi.org/10.1186/cc5054 | Medline

[4.]

E. Potolidis, E. Vakouti, D. Georgopoulos.

Anemia in critically ill patients.

Yearbook of Intensive care and Emergency Medicine, pp. 491-504

[5.]

B.V. Nguyen, D.P. Bota, C. Melot, J.L. Vincent.

Time course of hemoglobin concentrations in nonbleeding Intensive Care Unit patients.

Crit Care Med, 31 (2003), pp. 406-410

http://dx.doi.org/10.1097/01.CCM.0000048623.00778.3F | Medline

[6.]

S. Saxena, H. Belzberg, M. Chogyoji, S. Wilcox, I.A. Shulman.

Reducing phlebotomy losses by streamlining laboratory test ordering in a Surgical Intensive Care Unit.

Lab Med, 34 (2003), pp. 728-732

[7.]

J.C. Dale, S.G. Ruby.

Specimen collection volumes for laboratory tests.

Arch Pathol Lab Med, 127 (2003), pp. 162-168

http://dx.doi.org/10.1043/0003-9985(2003)127<162:SCVFL>2.0.CO;2 | Medline

[8.]

C.R. Harber, K.J. Sosnowski, R.M. Hedge.

Highly conservative phlebotomy in adult intensive care - a prospective randomized controlled trial.

Anaesth Intensive Care, 34 (2006), pp. 434-437

Medline

[9.]

E. Gleason, S. Grossman, C. Campbell.

Minimizing diagnostic blood loss in critically ill patients.

Am J Crit Care, 1 (1992), pp. 85-90

Medline

[10.]

M.J. Silver, Y.H. Li, L.A. Gragg, F. Jubran, J.K. Stoller.

Reduction of blood loss from diagnostic sampling in critically ill patients using a blood-conserving arterial line system.

Chest, 104 (1993), pp. 1711-1715

Medline

[11.]

C.M. MacIsaac, J.J. Presneill, C.A. Boyce, K.L. Byron, J.F. Cade.

The influence of a blood conserving device on anaemia in intensive care patients.

Anesth Intensive Care, 31 (2003), pp. 653-657

[12.]

T.S. Walsh, R.J. Lee, C.R. Maciver, M. Garrioch, F. Mackirdy, A.R. Binning, et al.

Anemia during at discharge from intensive care: the impact of restrictive blood transfusion practice.

Intensive Care Med, 32 (2006), pp. 100-109

http://dx.doi.org/10.1007/s00134-005-2855-2 | Medline

[13.]

N. Von Ahsen, C. Muller, S. Serke, U. Frei, K. Eckhardt.

Important role of nondiagnostic blood loss and blunted erythropoietic response in the anemia of medical intensive care patients.

Crit Care Med, 29 (2001), pp. S141-S150

[14.]

M. Muñoz, A. Romero, M. Morales, A. Campo, J.A. García-Erce, G. Ramírez.

Metabolismo del hierro, inflamación y anemia en pacientes en estado crítico: un estudio transversal.

Nutr Hosp, 20 (2005), pp. 115-120

Medline

Indexada en:

Síguenos:

Suscribirse:

Indexada en:

Síguenos:

Suscribirse:

Suscríbase a la newsletter