Hospital-Acquired Anemia

45 Pages·2013·1.38 MB·English

Hospital-Acquired Anemia:
Epidemiology, Prevention and
Management in Patients with Acute
Coronary Syndromes
Adam C. Salisbury, MD, MSc
January 23, 2012
Case
64 year old woman with no cardiac history,

medical history of hypertension, type II
diabetes
Presents Friday night to her local ED sudden

substernal chest pain, EKG shows
anterolateral ST depression
Symptoms resolve with nitroglycerin, metoprolol

Started on aspirin, clopidogrel and heparin

Transferred to Saint Luke’s Hospital

Baseline hemoglobin 12.4 g/dL, admit

creatinine 1.5 mg/dL
Clinical Scenario
Remains pain free, admission EKG shows

resolution of her ST segment changes
Managed medically over the weekend

Coronary angiography Monday

Pre-procedure : Hgb 11.0 g/dL, creatinine 1.3

95% mid-distal LAD lesion stented with a single

drug-eluting stent
Manual compression for sheath pull; small

hematoma
Discharged home next day – Hgb 10.7 g/dL

Hospital-Acquired Anemia (HAA)
Not an uncommon scenario…normal

admission hemoglobin, anemic at
discharge
How frequent at the time of acute coronary

syndrome (ACS)?
Is this important?

Poor outcomes?

What can/should we do about HAA?

Chronic Anemia & Outcomes After
Acute Coronary Syndromes
Chronic anemia associated

with poorer survival and
worse health status acute
coronary syndrome patients
Sabatine et al. Circulation. 2005;111:2042-2049
Anker et al. Eur Heart J. 2009(30):1331-39
Anemia and Mortality
Decreased blood oxygen

carrying capacity
Promote arrhythmia

Exacerbate myocardial

ischemia
Increase sympathetic tone

Exacerbate shock in setting

of compromised ventricular
function
Levy, et al. Am J Physiol. 1993;265:H340-349
Levy, et al. J Trauma. 1996;41:416-423
Chronic Anemia & Outcomes After
Acute Coronary Syndromes
Is it actionable?

Challenges in addressing chronic anemia

Complex interplay of underlying illness and

inflammation
No opportunity for prevention

Treatments - disappointing results

Transfusion ‘benefit’ transient and may increase mortality

Erythropoietin stimulating agents augment hemoglobin but increase

risk for stroke and thromboembolic events
Hospital-Acquired Anemia (HAA)
New anemia in patients with normal

admission hemoglobin
Common at the time of acute coronary

syndromes
Associated with greater mortality

Worse physical functioning

Commonly persistent in recovery after ACS

Salisbury, et. al. Circ Cardiovasc Qual Outcomes; 2010: 3(4): 337-46.
Salisbury, et. al. Am J Cardiol; 2011: 108(7): 949-54.
Salisbury, et. al. Am Heart J; 2011: 162(2): 300-309.e3