How Hospitals Make You Anemic.

And, how to prevent it.

Photo by Hush Naidoo Jade Photography on Unsplash

What Is Anemia

One of the more common health concerns is anemia - which is technically a low concentration of Hemoglobin in the blood.

Hemoglobin is the oxygen-carrying protein in red blood cells.

Normal hemoglobin concentrations come in a range and vary by sex:

• Men: 14 - 17.5 grams per deciLiter

• Women: 12.3 - 15.3 grams per deciLiter

You may be wondering how they get such a precise normal range, and indeed what constitutes “normal.” These are good questions to be sure, but not the concern of this article.

Low hemoglobin becomes concerning for men under 13 g/dL, and for women under 12 g/dL.

For women, the most common form of anemia tends to be iron-deficiency anemia and related to menstruation.

One of the least commonly understood causes of anemia, both for the general public and even the doctors who are treating them, is hospital-acquired anemia.

Most people will have never heard of this before.

But, it is very real.

In one study performed at the Cleveland Clinic, they found that 74% of people who were admitted to the hospital between 2009 and 2011 developed anemia during hospitalization!

Just think about that for a second.

Out of 188 447 hospitalized patients, a whopping 139 087 became anemic! To add insult to injury, about 30% were severely anemic (hemoglobin < 9 g/dL).

Numbers which border on unbelievable.

This does not include patients who were already slightly anemic before their admission, and got far worse during hospitalization.

What Is Hospital-Acquired Anemia?

Put simply, hospital-acquired anemia is diagnosis used to describe when a person who was previously healthy becomes anemic during hospitalization.

It is a bit of nebulous term because it does not identify a cause. As we will discuss, the causes multiple and are often unknown to the team of doctors and nurses who are taking care of the patients.

The natural question to follow from the information above is, if this is so common, how on earth do the healthcare team not know about it?

Do they know about it?

First, a caveat.

Of course, there are some doctors who certainly do know about it - which is how I know about it. These doctors tend to be a combination of well-experience or thoughtful about the things they do to their patients.

Unfortunately, this sort of doctor is increasingly rare.

How do I know this?

When a patient’s hemoglobin starts to trend downward, the team who is taking care of the patient starts to get worried. They start to consider all of the different causes of acute loss of hemoglobin.

• Is it autoimmune?

• Is it infectious?

• Are they bleeding?

This leads to several tests.

One of these tests are radiologic scans which look for active bleeding. These include nuclear scintigraphy (RBC scan) or CT angiography looking for active hemorrhage. If they are really desperate, they may even order invasive digital-subtraction angiography.

Unfortunately for the patients, both the anemia and ensuing testing come with harms and complications. More often than not, these tests are inconclusive.

For the patient, this usual results in continued loss of hemoglobin until it drops below 7 g/dL.

Once that happens, the healthcare team will trigger a transfusion protocol. It is generally frowned upon to discharge a patient with a hemoglobin < 7 g/dL.

Transfusion of foreign blood is not without its complications. Sometimes, this complication triggers the patient’s immune system to start destroying red blood cells…which can result in their own blood getting caught in the crossfire. And so, the cycle of low hemoglobin and transfusion perpetuate.

So, what’s really causing the anemia? What is the hospital doing?

Causes of Hospital-acquired Anemia

A simple google search will reveal that there are several listed causes including:

• Blood tests

• Bleeding

• Infection

• and, paradoxically, blood transfusions

In my opinion, these miss out on the most common and easily avoidable causes.