(214) Acute Anemia in Cardiogenic Shock Patients With Mechanical Circulatory Support Devices

Introduction: Acute blood loss anemia (ABLA) is a common and serious complication in patients with cardiogenic shock requiring various mechanical circulatory support devices (MCSD). In our study, we aim to identify the etiologies, incidence, and risk factors for ABLA in patients requiring MCSD.

Methods: A retrospective cohort analysis was conducted on 119 patients diagnosed with cardiogenic shock who required MCSD from 2021 to 2022. Patient demographics, hemoglobin levels at various stages of hospitalization, transfusion data, and associated complications were recorded and analyzed.

Results: Total patients: 119, Average age: 66 years (range: 30-92 years), 35% females, 48.7% White
Admission Hb: Average: 13.4 g/dL, Mode: 11.8 g/dL, Range: 6.8 - 18.8 g/dL, Lowest Hb during Hospital Stay: Average: 7.49 g/dL, Mode: 6.5 g/dL, Range: 4.5 - 14.4 g/dL, Discharge Hb: Average: 9.94 g/dL, Mode: 8.8 g/dL, Range: 6.3 - 13.6 g/dL.
71.4% (85/119) of patients received Packed Red Blood Cells (PRBC) transfusions. Average units of PRBC transfused: 5.49 units, Range: 1 - 28 units, Mode: 2 units. Fresh Frozen Plasma (FFP) and/or platelets were transfused to 33.6% (40/119) of patients.
Complications Incidence( modifiable risk factors) in Patients Requiring PRBC: Access site bleeding/hematoma: 82.5%, Hemolysis: 64.7%
Highest S.LDH levels: Average: 2536.3 U/L, Range: 375 - 18,592 U/L,
Transfusion Requirement Based on Demographics:
Females: 76%, Males: 68%, White: 49%, Non-White: 50%, Non-White women: 66%
Average LOS for patients with PRBC transfusion: 13.08 days
Average LOS for patients without PRBC transfusion: 6.95 days
Mortality in patients receiving PRBC transfusions: 45%
Mortality in patients not receiving PRBC transfusions: 2.3%

Conclusions: Access site bleeding and hemolysis were the primary causes of acute blood loss anemia (ABLA) in our cohort. Despite high transfusion rates, anemia remained prevalent at discharge, which is detrimental to cardiac patients, especially those with heart failure. This highlights the need for best practices in MCSD insertion, secure positioning, and proper anticoagulation strategies. Meticulous ICU monitoring for device positioning, support levels, and maintaining optimal fluid status to prevent hemolysis are essential. Higher rate of transfusion in women should be investigated more.