### Description

Milbrandt et al developed the Intensive Care Unit Anemia Score to help identify patients who will develop late anemia. This can help identify patients who may benefit from interventions to avoid blood transfusion based on data collected shortly after admission to the ICU. The authors are from the University of Pittsburgh.

Late anemia is a hemoglobin <= 7 g/dL on ICU day 7 or later

Parameters:

(1) arterial lactate concentration

(2) need for inotropic support

(3) surgical patient

(4) non-emergency surgery

(5) hemoglobin concentration

 Parameter Finding Points arterial lactate concentration normal (<= 1.5 mg/dL) 0 abnormal (> 1.5 mg/dL 6 need for inotropes none 0 present 5 surgical patient no 0 emergent 11 non-emergent 16 (11 + 5) hemoglobin in g/dL MAX(0, 3 * (14 - (hemoglobin in g/dL)))

where:

• Although the paper uses arterial lactate units of mg/dL, I have a suspicion that the units should be mmol/L. See the normal ranges in Tietz's Clinical Guide to Laboratory Tests, Third Edition.

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: 0

• maximum score: depends on hemoglobin, but rarely > 50

• The higher the score the greater the risk of later anemia.

 Total Score Probability of Late Anemia 5 5.7% 10 8.4% 15 13% 20 19.3% 25 26.9% 30 37.9% 32 42.4% 35 49.6% 40 61.7% 45 72.8% 50 82%

When examined in Minitab, the following equations are derived:

probability of late anemia if total score less than or equal to 25 =

= (0.03286 * ((score)^2)) + (0.08029 * (score)) + 4.42

probability of late anemia if total score 25 or more points =

= (-0.007074 * ((score)^2)) + (2.78 * (score)) - 38.72