Is it safe to discharge patients with anemia?
Background: Anemia is common in hospitalized patients and is associated with short- and long-term morbidity and mortality. Current evidence shows that reduced red blood cell (RBC) use and more restrictive transfusion practices do not increase short-term mortality; however, few data exist on the long-term outcomes of anemia.
Dr. David Schmit
Study design: Retrospective cohort study.
Setting: Integrated health care system (Kaiser Permanente) with 21 hospitals located in Northern California.
Synopsis: From 2010 to 2014, there were 801,261 hospitalizations among 445,371 patients who survived to discharge. The prevalence of moderate anemia (hemoglobin between 7 and 10 g/dL) at hospital discharge increased from 20% to 25% (P less than .001) while RBC transfusions decreased by 28% (P less than .001). Resolution of moderate anemia within 6 months of hospital discharge decreased from 42% to 34% (P less than .001). RBC transfusion and rehospitalization rates at 6 months decreased as well. During the study period, adjusted 6-month mortality decreased from 16.1% to 15.6% (P = .04) in patients with moderate anemia.
Given the retrospective design of this study, data must be interpreted with caution in determining a causal relationship. The authors also acknowledge that there may be unmeasured confounding variables not accounted for in the study results.
Bottom line: Despite higher rates of moderate anemia at discharge, there was not an associated rise in subsequent RBC transfusions, readmissions, or mortality in the 6 months after hospital discharge.
Citation: Roubinian NH et al. Long-term outcomes among patients discharged from the hospital with moderate anemia: A retrospective cohort study. Ann Intern Med. 2019 Jan 14. doi: 10.7326/M17-3253.
Dr. Schmit is an associate professor of medicine in the division of general and hospital medicine at UT Health San Antonio and a hospitalist at South Texas Veterans Health Care System, also in San Antonio.
