• Shah Zeb Department of Cardiology, Institut Jantung Negara, Malaysia.
  • Said Zaman Department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, Pakistan.
  • Junaid Zeb Department of Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan.
  • Mohammad Waqas Department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, Pakistan.
  • Mohammad Adil Department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, Pakistan.
  • Rafiq Zeb Khyber Teaching Hospital Peshawar, Pakistan.


Background: Anaemia is common in patients admitted with acute myocardial infarction (AMI) and can badly affect the short and long term outcomes. Hospital acquired anaemia (HAA) is a type of anaemia which develops in patients during hospitalization with a normal haemoglobin level at the time of admission. There is very scant data regarding the causes for hospital acquired anaemia. This study was conducted in order to determine the causes and baseline characteristics of low haemoglobin level in AMI. Methods: This descriptive study was performed in Lady Reading Hospital Peshawar from 1st June 2013 to 31st May 2014. All the patients with AMI having normal baseline haemoglobin level at admission were included. Haemoglobin was rechecked on 5th day of admission to see whether patient develops HAA or not. Results: A total of 456 consecutive patients with AMI were screened for low haemoglobin. Low haemoglobin level (haemoglobin <12 g/dl in female and <13 g/dl in male) on 4th day of admission was found in 84 patients. The mean age of these 84 patients were 59.4±12.4 years, 39 (46.4%) were female and 45 (54%) were male. Patients with age >70 years were 12 (14.3%). hypertensives were 34 (40.5%), diabetics were 24 (28.6%), CKD was seen in 11 (13.1%), dyslipidemia in 17 (20.2%), and smokers were 16 (19%). Upper GI bleed was found in 23 (27%), lower GI bleed in 7 (8.3%), hematuria in 6 (7.1%), possible coronary intervention in 7 (8.3%), and more than one cause in 14 (16.6%) patients, while no cause was found in 27 (32.14%) patients. Conclusion: One third of patients had no discernible cause of low haemoglobin, while one fourth of patients had isolated upper GI bleed as the main cause for hospital acquired low Hb.

Keywords: Acute MI, Hospital acquired anaemia (HAA), GI bleed, Haemoglobin

Pak J Physiol 2017;13(2):22–4


1. Salisbury AC, Alexander KP, Reid KJ, Masoudi FA, Rathore SS, Wang TY, et al. Incidence, correlates, and outcomes of acute hospital-acquired anemia in patients with acute myocardial infarction. Circ C ardiovasc Qual Outcomes 2010;3:337–46.
2. Salisbury AC, Amin AP, Reid KJ, Wang TY, Masoudi FA, Chan PS, et al. Hospital-acquired anemia and in-hospital mortality in patients with acute myocardial infarction. Am Heart J 2011;162:300–9.
3. Salisbury AC, Reid KJ, Alexander KP, Masoudi FA, Lai SM, Chan PS, et al. Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction. Arch Intern Med 2011;171:1646–53.
4. Sattur S, Harjai KJ, Narula A, Devarakonda S, Orshaw P, Yaeger K. The influence of anemia after percutaneous coronary intervention on clinical outcomes. Clin Cardiol 2009;32(7):373–9.
5. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001;345:1230–6.
6. Aronson D, Suleiman M, Agmon Y, Suleiman A, Blich M, Kapeliovich M, et al. Changes in haemoglobin levels during hospital course and long-term outcome after acute myocardial infarction. Eur Heart J 2007;28:1289–96.
7. Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK, et al. Baseline risk of major bleeding in non-ST-segment elevation myocardial infarction: the CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation 2009;119:1873–82.
8. Moscucci M, Fox KA, Cannon CP, Klein W, Lopez-Sendon J, Montalescot G, et al. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2003;24:1815–23.
9. Rao SV, O’Grady K, Pieper KS, Granger CB, Newby LK, Van de Werf F, et al. Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol 2005;96:1200–6.
10. Rao SV, Ou FS, Wang TY, Roe MT, Brindis R, Rumsfeld JS, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv 2008;1(4):379–86.
11. Cantor WJ, Mahaffey KW, Huang Z, Das P, Gulba DC, Glezer S, et al. Bleeding complications in patients with acute coronary syndrome undergoing early invasive management can be reduced with radial access, smaller sheath sizes, and timely sheath removal. Catheter Cardiovasc Interv 2007;69:73–83.
12. Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, et al. Bivalirudin in patients undergoing primary angioplasty for acute myocardial infarction (HORIZONS-AMI): 1-year results of a randomized controlled trial. Lancet 2009;374:1149–59.
13. Stone GW, White HD, Ohman EM, Bertrand ME, Lincoff AM, McLaurin BT, et al. Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial. Lancet 2007;369:907–19.
How to Cite
ZEB, Shah et al. CAUSES OF LOW HAEMOGLOBIN LEVEL IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION. Pakistan Journal of Physiology, [S.l.], v. 13, n. 2, p. 22-24, june 2017. ISSN 2073-1183. Available at: <>. Date accessed: 22 jan. 2018.

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