{"doi":"10.1001/jamanetworkopen.2025.2353","title":"Practical Anemia Bundle and Hemoglobin Recovery in Critical Illness","abstract":"Importance: Anemia is a common complication of surgery and acute illness that is associated with adverse clinical outcomes. The role of anemia prevention and treatment strategies in this setting remains unclear. Objective: To evaluate the effect of a multifaceted anemia management bundle vs standard care on posthospitalization hemoglobin recovery and multidimensional functional outcomes in survivors of acute illness. Design, Setting, and Participants: This parallel group randomized clinical trial, known as the Practical Anemia Bundle for Sustained Blood Recovery, was conducted at postsurgical and medical intensive care units at a large US medical center. Critically ill patients (aged ≥18 years) with moderate to severe anemia (hemoglobin concentration <10 g/dL) were enrolled between March 2022 and November 2023. Participants were randomly assigned 1:1 to the intervention or standard care group. Intention-to-treat analyses were performed between July 2024 and January 2025. Intervention: The intervention bundle was delivered throughout the duration of hospitalization and included optimized phlebotomy practices, clinical decision support, and pharmacological anemia treatment with intravenous iron. Main Outcomes and Measures: The primary outcome was the mean difference in hemoglobin concentration at 1 month after hospital discharge. Results: A total of 100 patients (median [IQR] age, 68 [61-72] years; 57 men [57.0%]; 65 [65.0%] with postsurgical admission to the intensive care unit) were enrolled during acute illness. Forty-nine patients (49.0%) were assigned to receive the intervention, and 51 (51.0%) were assigned to receive standard care. Hemoglobin concentration at 1 month after discharge was greater in patients receiving the intervention vs standard care (median [IQR], 12.2 [11.8-13.0] g/dL vs 11.5 [10.2-12.6] g/dL; adjusted mean difference, 0.69 [95% CI, 0.13-1.20] g/dL; P = .02). Conclusions and Relevance: This randomized clinical trial found that a multifaceted anemia prevention and treatment bundle was feasible, was well tolerated, and improved posthospitalization hemoglobin concentrations up to 3 months in critically ill adults. These findings can inform the design of future trials. Trial Registration: ClinicalTrials.gov Identifier: NCT05167734.","journal":"JAMA Network Open","year":2025,"id":513253,"datarank":0.39392851682525415,"base_score":2.3978952727983707,"endowment":2.3978952727983707,"self_citation_contribution":0.3596842909197557,"citation_network_contribution":0.03424422590549845,"self_endowment_contribution":0.3596842909197557,"citer_contribution":0.03424422590549845,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":8,"citers_with_citation_signal":2,"citers_with_endowment":2,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9613,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT05167734"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":733976,"name":"Matthew L. 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Charnin","orcid":"0000-0002-1225-2729","position":9,"is_corresponding":false},{"id":914729,"name":"Brenda Anderson","orcid":null,"position":10,"is_corresponding":false},{"id":968819,"name":"Brad S. Karon","orcid":null,"position":11,"is_corresponding":false},{"id":273722,"name":"Andrea Cheville","orcid":"0000-0001-7668-6115","position":12,"is_corresponding":false},{"id":363472,"name":"Ognjen Gajic","orcid":"0000-0003-4218-0890","position":13,"is_corresponding":false},{"id":292111,"name":"Daryl J. Kor","orcid":"0000-0001-9110-1648","position":14,"is_corresponding":false},{"id":292105,"name":"Matthew A. Warner","orcid":"0000-0002-6625-8755","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":null,"created_at":"2026-07-19T02:48:17.908238Z","pmid":"40152861","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}