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Diagnostic phlebotomy impacts hemoglobin in cirrhosis
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LAS VEGAS — Phlebotomy was associated with changes in hemoglobin and hematocrit levels in patients hospitalized with cirrhosis, per research presented during a liver plenary at ACG 2016.
“These patients in particular are known to be at higher risk of bleeding; therefore, even the slightest increase in hemoglobin can raise concerns for bleeding … when it could be related to phlebotomy,” Vincent C. Ganapini, DO, of Indiana University School of Medicine, said during his presentation.
Ganapini and Suthat Liangpunsakul, MD, MPH, of Indiana University School of Medicine, evaluated medical records of 482 adult patients admitted to the inpatient liver service at Indiana University Hospital in 2013, and included 312 in the final analysis (mean age56 ± 10 years; 64% men; 89% white).
Variables measured included total phlebotomy volume based on the number and type of blood tubes collected during admission and the change in hemoglobin (Hb) from admission to the hospital to discharge. The average length of hospital stay was 8 days.
The mean Hb at hospital admission was 10.5 ± 2.3 g/dL and 9.4 ± 1.7 g/dL upon discharge (P = .001) with a corresponding mean difference of –1.1 ± 1.7 g/dL. The average phlebotomy volume was 183 ± 174 mL and average blood transfusion was 1.7 ± 0.4 units.
Age, Hb level at hospital admission and the volume of phlebotomy predicted changes in Hb via univariate analysis, but not the length of hospital stay. After adjusting for multiple covariates in multivariate analysis, the volume of phlebotomy remained a strong predictor of drop in Hb (P < .0001).
“Knowing the expected changes in Hb and the volume of diagnostic phlebotomy will help guide when to investigate anemia and trigger further investigation in these patients,” Ganapini concluded – by Melinda Stevens
Reference:
Ganapini VC and Liangpunsakul S. Abstract #51. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 14-19, 2016; Las Vegas, NV.
Disclosure: The researchers report no relevant financial disclosures.