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Anemia In The Hospitalized Patient: Current Evidence-Based Strategies For Evaluation And Treatment
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Anemia In The Hospitalized Patient: Current Evidence-Based Strategies For Evaluation And Treatment - $35.00

Publication Date

May 2014 (Volume 2, Number 5)


This issue includes 4 AMA PRA Category 1 CreditsTM; and 4 AOA Cetegory 2A or 2B CME credits

CME Objectives

After reading this article, you should be able to:

  1. Carry out a stepwise workup for causes of anemia.
  2. Prescribe oral and parenteral iron formulation for patients with iron deficiency anemia.
  3. Identify the indications for blood transfusion.
  4. Describe the importance in using restrictive thresholds for blood transfusion.


Rubens S. Ribeiro, MD
Senior Staff Physician, Division of Hospital Medicine, Department of Internal Medicine, Henry Ford Health System, Detroit, MI

Marcello Frederico Santos Schmidt, MD
Internal Medicine Residency, McLaren Flint/Michigan State University, Flint, MI

Peer Reviewers

Eric Kupersmith, MD
Division Head, Hospital Medicine, Deputy Chief of Medicine, Deputy Chief Medical Officer, Cooper University Hospital, Camden, NJ

Susan Coutinho McAllister, MD
Medical Director, Care Coordination, Cooper University Hospital, Assistant Professor of Medicine, Cooper Medical School of Rowan University, Camden, NJ



Anemia is a prevalent condition in the acutely ill and hospitalized patient. Its severity can vary from mild comorbidity to life-threatening, and many studies show that its presence has been associated with poorer outcomes and increased mortality. Nevertheless, the indications and threshold for transfusion in anemia have become stricter, as the simple correction of hemoglobin is not always associated with better outcomes and can lead to increased mortality. This review examines the current literature on the etiology, pathogenesis, diagnosis, and treatment of anemia in the hospitalized patient, including the indications and potential outcomes of blood transfusions, parenteral and enteral iron supplementation, and the indications and cautions for the use of erythropoiesis-stimulating agents.

Excerpt From This Issue

You are co-managing a 72-year-old patient who, 2 days ago, underwent elective right total hip arthroplasty with no complications and an estimated blood loss of 700 mL. He has hypertension, coronary artery disease, and stage 3 chronic kidney disease. Laboratory studies 2 weeks prior to surgery revealed a chronically low hemoglobin of 10.5 g/dL, mean corpuscular volume of 85 fL, reticulocytes of 1%, and creatinine of 2.2 mg/dL. He normally takes aspirin, lisinopril, metoprolol, and ferrous sulfate. He had his last colonoscopy 2 years before, which was unremarkable. On postoperative day 2, the orthopedic surgeon indicated in her notes that she believed the patient should be transfused because his hemoglobin dropped to 8.2 g/dL, and she was concerned about the concomitant coronary artery disease. The patient complains of moderate pain on the surgical site, but no lightheadedness or palpitations. His vital signs are unremarkable, and, on examination, there is no evidence of blood loss at the surgical site. After you discuss the existing evidence on blood transfusion, the surgeon agrees the risk is higher than any benefit; however, she tells you this patient is scheduled to return in 4 weeks for a similar surgery on the left hip and asks you what can be done to minimize the need of blood transfusion after the second surgery.

A 26-year-old man came to the emergency department because of diarrhea and abdominal pain. He was diagnosed 2 years ago with Crohn disease, for which he has been taking mesalamine. He also takes ferrous sulfate for anemia, which was diagnosed along with the Crohn disease, but he confesses that it aggravates his abdominal discomfort, so he has not taken it for the past week. After a thorough history and physical examination, you diagnose severe Crohn disease reactivation. His hemoglobin on admission is 10 g/dL. You review his chart and notice that this had been his baseline hemoglobin for the last year. His anemia has already been investigated, and he had a low ferritin, low iron saturation, and high total iron-binding capacity. He has had a recent colonoscopy to evaluate for the inflammatory bowel disease. You begin to assess how to effectively replace iron in this patient...

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