The prevalence and characteristics of anaemia at discharge home after intensive care

Abstract

Objective: To document the prevalence of anaemia among ICU survivors at the time of discharge home and to document red cell morphology among anaemic patients.

Design and setting: Observational cohort study in a single-centre teaching hospital.

Patients and participants: Three cohorts of ICU admissions over a 3-year period managed with restrictive ICU transfusion practice. The study group comprised the 283 patients who survived and were discharged directly home from our hospital.

Measurements and results: The median time from ICU discharge to hospital discharge was 13[Symbol: see text]days (IQR 6-22, range 1-119). Using the last recorded Hb concentration 77.4% (95% CI 72.2-82.1) of patients were anaemic, 32.5% (27.3-38.2) had Hb less than 100 g/l, and 11.3% (8.1-15.5) had Hb less than 90 g/l at hospital discharge. Patients who spent longer in intensive care and in hospital after ICU discharge were more likely to be discharged home anaemic. The strongest predictor of discharge home with Hb less than 100 g/l was Hb at the time of ICU discharge. Multivariate regression analysis showed patient age, gender, APACHE II score, and ICU length of stay not to be independent predictors after including the ICU discharge Hb. Among anaemic patients 82% had normochromic normocytic red cell indices, but 12% had red cell hypochromasia and/or microcytosis, which may indicate iron deficiency.

Conclusions: Anaemia is highly prevalent among survivors of critical illness and persists until hospital discharge. Most patients have red cell morphology similar to "anaemia of chronic disease".