Do Blood Tests Cause Anemia in Hospitalized Patients?

The Effect of Diagnostic Phlebotomy on Hemoglobin and Hematocrit Levels

Authors

  • Paaladinesh Thavendiranathan MD, MSc,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Akshay Bagai MD,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Albert Ebidia RT,

    1. Shared Information Management Systems, University Health Network, Toronto, Ontario, Canada
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  • Allan S. Detsky MD, PhD,

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Niteesh K. Choudhry MD, PhD

    1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    2. Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
    3. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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  • The authors have no conflicts of interest.

Address correspondence and requests for reprints to Dr. Choudhry: Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120 (e-mail: mchoudhry@partners.org).

Abstract

Objective: To determine whether phlebotomy contributes to changes in hemoglobin and hematocrit levels in hospitalized general internal medicine patients.

Design: Retrospective cohort study.

Setting: General internal medicine inpatient service at a tertiary care hospital.

Participants: All adult patients discharged from the Toronto General Hospital's internal medicine service between January 1 and June 30, 2001. A total of 989 hospitalizations were reviewed and 404 hospitalizations were included in our analysis.

Measurements And Main Results: Mean (SD) hemoglobin and hematocrit changes during hospitalization were 7.9 (12.6) g/L (P<.0001) and 2.1% (3.8%) (P<.0001), respectively. The mean (SD) volume of phlebotomy during hospital stay was 74.6 (52.1) mL. On univariate analysis, changes in hemoglobin and hematocrit were predicted by the volume of phlebotomy, length of hospital stay, admission hemoglobin/hematocrit value, age, Charlson comorbidity index, and admission intravascular volume status. The volume of phlebotomy remained a strong predictor of drop in hemoglobin and hematocrit after adjusting for other predictors using multivariate analysis (P<.0001). On average, every 100 mL of phlebotomy was associated with a decrease in hemoglobin and hematocrit of 7.0 g/L and 1.9%, respectively.

Conclusions: Phlebotomy is highly associated with changes in hemoglobin and hematocrit levels for patients admitted to an internal medicine service and can contribute to anemia. This anemia, in turn, may have significant consequences, especially for patients with cardiorespiratory diseases. Knowing the expected changes in hemoglobin and hematocrit due to diagnostic phlebotomy will help guide when to investigate anemia in hospitalized patients.

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