New research from the Mayo Clinic suggests that an anemia prevention and treatment bundle of optimized phlebotomy practices, clinical decision support and pharmacological anemia treatment with intravenous iron may improve posthospitalization hemoglobin recovery among critically ill adults. The findings were published last week in
JAMA.
In the unblinded trial, Practical Anemia Bundle for Sustained Blood Recovery, investigators randomized 100 critically ill patients with moderate to severe anemia (hemoglobin concentration less than 10 g/dL within 24 hours of enrollment) to receive either the prevention and treatment bundle (49 patients) or standard care (51 patients). The primary outcome was the mean difference in hemoglobin concentration one month after hospital discharge.
While hemoglobin concentrations did not significantly differ at ICU or hospital discharge, the median hemoglobin concentration one month after hospital discharge was 12.2 g/dL (IQR, 11.8-13.0) in the intervention group and 11.5 g/dL (IQR, 10.2-12.6) in the standard care group. Investigators observed similar findings at the three-month follow-up.
Although the trial was not designed to identify significant changes in secondary outcomes, the intervention group reported reduced fatigue, improved physical function and lower levels of depression and anxiety. While these findings were not statistically significant, they suggest that structured anemia management may contribute to broader functional recovery after critical illness.
According to investigators, the findings build on those from previous trials, which suggested that IV iron effectively augments hemoglobin recovery. However, the authors emphasized that surviving surgery and critical illness does not guarantee meaningful functional recovery. They concluded that the study and its findings can inform the design of future trials to evaluate how anemia management strategies may improve patient outcomes after critical illness.
An
accompanying editorial by Timothy S. Walsh, MD, also highlighted the clinical significance of post–critical illness anemia and its impact on patient recovery. He noted that while restrictive transfusion strategies are beneficial in the ICU, they often contribute to prolonged anemia, which remains understudied.
Given this gap in research, Walsh emphasized the importance of the study, commending its robust design while acknowledging potential performance bias due to the lack of blinding among clinicians and participants. However, he suggested that any bias likely underestimated rather than exaggerated the intervention’s effect.
Walsh also explored which components of the intervention bundle were most influential in improving hemoglobin levels. Since the hemoglobin difference emerged only after discharge and persisted for months, he speculated that IV iron played the most significant role. He also cautioned that the study’s focus on surgical ICU patients may limit generalizability to medical ICU patients.
Finally, Walsh stressed that while hemoglobin concentration is a valuable biomarker, he emphasized the importance of patient-centered outcomes like fatigue, physical function and quality of life. He believes that trends favoring intervention suggest potential benefits that warrant further research.
“We now need adequately powered trials to determine the clinical effectiveness of these interventions for patient-centered outcomes and evaluation of the economic benefits of implementing them at scale as part of best practice,” he wrote.
