IATROGENIC ANAEMIA IN PAEDIATRIC ICU PATIENTS AND IT'S DETERMINANTS IN LOWER MIDDLE INCOME COUNTRY

Abstract

Background: Iatrogenic anemia is a frequent but preventable condition in patients in PICU. It frequently occurs when blood is sampled repeatedly, patients are in the intensive care unit for extended periods, their underlying condition is severe, the blood is monitored invasively, and there is poor blood conservation. Fewer resources and increased patient burden, combined with the limited resources, may also exacerbate the burden of anemia in lower middle-income countries in the case of critically ill children.

Objective: To assess the incidence of iatrogenic anemia and its risk factors in PICU of a lower middle-income country.

Methods: A descriptive cross-sectional study was done in the Pediatric ICU of The Children's Hospital Lahore from September 2025 to January 2026. The sample size was determined with the formula provided by WHO and 288 patients were included. Information obtained included age, gender, diagnosis, length of stay in a hospital intensive care unit, number of blood samples, total blood volume collected, baseline hemoglobin level, mechanical ventilation, transfusion history, and final hemoglobin level. The descriptive statistics and association testing were used for analyzing data.

Results: For 288 PICU patients, 112 patients (38.9%) were found to have iatrogenic anemia. Frequent blood sampling, higher volume of blood taken for sampling and other factors associated with iatrogenic anemia such as prolonged stay in the ICU, younger age, mechanical ventilation and low baseline hemoglobin levels were important factors.

Conclusion: Iatrogenic anemia is common in the PICU setting and is well correlated with the number of phlebotomy procedures and length of stay in the PICU. Conservation of blood, the rational use of laboratory tests, and the use of a pediatric sampling tube could contribute to preventing unnecessary anemia.