(827) Anemia Recovery After Pyelonephritis

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Lisa R. Thiele, MD, MPH (she/her/hers)

Resident
University of Texas Southwestern
Dallas, TX, United States

Coauthor(s)

Sara I. Jones, MD (she/her/hers)

Duke University
Durham, North Carolina, United States
SK

Sainath Kondapaneni, BS

Medical Student
University of Texas Southwestern
Dallas, Texas, United States
JP

Jessica E. Pruszynski, PhD

University of Texas Southwestern
Dallas, Texas, United States
Elaine L. Duryea, MD

Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Catherine Y. Spong, MD

Professor and Chair
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Objective: While pregnant patients with pyelonephritis commonly develop anemia secondary to endotoxin-induced hemolysis, the rate of hematologic recovery is not known. This study aimed to detail the hematologic trajectory during and after antepartum pyelonephritis.

Study Design: Patients with antepartum admissions for pyelonephritis between January 1, 2022 and December 1, 2022 who delivered at our institution at least 7 days following admission for pyelonephritis were included. The primary outcome was change in hematocrit (Hct) from its nadir during admission for pyelonephritis to follow-up. Data collected included hematologic data, patient demographics, medical comorbidities, and characteristics regarding pyelonephritis and delivery admissions. Statistical analysis included t-tests, Kruskal-Wallis, and chi-square tests.

Results: Of 78 patients meeting inclusion criteria, the majority were nulliparous, of Hispanic ethnicity, and had an average age of 25.4. During pyelonephritis admissions, the average admission Hct was 33.2% (32.0-35.2) with an average nadir of 28.8% (26.7-30.6) occurring on hospital day 2 (1-3). 60% of patients had anemia at discharge from pyelonephritis admission. The mean rise in Hct from pyelonephritis admission nadir to first follow-up was 6.0+/-3.3% with an average rise of 1.63+/-2.4% per week (Figure). 6% of patients had anemia at delivery admission, with an average admission Hct of 35.9% (33.8-38.2). Patients with a greater Hct rise were found to have a lower mean nadir, more rapid rise, and higher Hct at delivery admission (p < 0.001), with no difference in initial Hct at pyelonephritis admission.

Conclusion: Following pyelonephritis infection in pregnancy, Hct levels steadily rise by an average of 1.63% per week, resulting in resolution of anemia prior to delivery. Patients with lower Hct during pyelonephritis admission demonstrate faster hematologic recovery and are less likely to be anemic at presentation for delivery.