Hemoglobin concentration variations over time in general medical inpatients.
BACKGROUND
A decrease in hemoglobin concentration [Hb] with no apparent cause is frequently observed in critically ill patients. Scarce information is available about this situation in general ward-admitted patients (GWAP).


OBJECTIVE
To describe [Hb] variation with no obvious cause in GWAP, and to estimate the prevalence and predictors of patients with [Hb] decreases > or =1.5 g/dL.


METHODS
Prospective, observational study in internal medicine GWAP, carried out at two teaching hospitals in Buenos Aires, Argentina. Patients with a history of, or admitted for diseases associated with decreases in [Hb], as well as those with length of stay less than three days, were excluded.


METHODS
Upon hospitalization, complete personal and clinical data were recorded. Furthermore, Katz index, APACHE II acute physiology score (APS) and Charlson score were calculated. [Hb] and hematocrit (HCT) were also assessed during hospitalization.


RESULTS
A total of 338 patients were evaluated, 131 were included. A mean [Hb] decrease of 0.71 g/dL was observed between admission and discharge (P < 0.001; 95% CI, 0.47-0.97). Forty-five percent of the included patients had decreases in [Hb] > or = 1.5 g/dL. This was associated with a higher APS, a higher [Hb] at admission, and a discharge diagnosis of infectious or gastrointestinal disease. No bleeding episodes were observed.


CONCLUSIONS
An [Hb] decrease was frequently observed during GWAP hospitalization with no evident blood loss. Even though this decrease has multiple causes, the severity of the acute illness seems to play a major role.
Department of Internal Medicine, Center for Medical Education and Clinical Research, Buenos Aires, Argentina. aguslang@yahoo.com
Agustin
A
Languasco
Languasco
L
Agustin
Nicolas
N
Cazap
Cazap
C
Nicolas
Sebastian
S
Marciano
Marciano
M
Sebastian
Marina
M
Huber
Huber
H
Marina
Abel
A
Novillo
Novillo
N
Abel
Fernando
F
Poletta
Poletta
P
Fernando
Matias
M
Milberg
Milberg
M
Matias
Dardo
D
Riveros
Riveros
R
Dardo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000453:epidemiology; D004906:Erythrocyte Count / Q000639:trends; D004909:Erythrocyte Indices / Q000502:physiology*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization / Q000639:trends*; D006784:Hospitals, Teaching / Q000639:trends; D006801:Humans; D007388:Internal Medicine / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
D006454:Hemoglobins