Perfil epidemiológico y clínico de la anemia en un servicio de urgencias hospitalarias

Résumé

BACKGROUND. Anemia worsens the prognosis of elderly patients and those with comorbid heart disease, chronic kidney disease, or cancer who come to a hospital emergency department (ED). Few studies have described the clinical profile of ED patients with anemia. OBJECTIVE. To describe the characteristics of ED patients with anemia and the management of their care. METHODS. Observational, cross-sectional descriptive analysis of the clinical characteristics of anemic patients treated in our hospital ED and the management of cases from November 1, 2015, to February 28, 2016. RESULTS. A total of 376 patients with anemia were attended (mean age, 76 years; women, 53.2%). Anemia was mild in most cases (79.1%) and related to nutrition in 73.7%. Anemic patients often had serious comorbid conditions such as cancer (29.5%), cardiopathy (eg, atrial fibrillation, in 24.7%, and heart failure, in 22.1%), and chronic kidney disease (19.9%). Patients had a prior history of anemia in 23.9% of cases, and 60.1% were taking platelet aggregation inhibitors or anticoagulants. Symptoms of anemia were the cause of 28.2% of the ED visits; the most common symptom was fatigue (16.8%). The diagnosis included in 23.5% of the records. The only contributing factors listed were a prior history of anemia or a hemoglobin concentration less than 8 g/dL (P < .001). Anemia was treated in 11.6% of the patients, by blood transfusion in all cases. A hemoglobin concentration lower than 8 g/dL was the only decisive factor for administering treatment (P < .001). CONCLUSIONS. Anemia is a common finding in hospital ED patients and is mild and related to nutrition in most cases. Frequent associations are heart failure, atrial fibrillation, cancer, chronic kidney disease, and medication with platelet aggregation inhibitors or anticoagulants. Anemia is diagnosed and treated in only a small proportion of patients with this finding. An ED visit offers an opportunity to improve the management of anemia, and better management might improve the prognosis for patients with multiple comorbidities.