Hemoglobinometry at the point of care with activation of a hospital transfusion pathway versus usual care for the early detection of anaemia in primary care: the ANHEMOG randomized controlled trial - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice BMC Prim Care . 2026 Mar 10;27:141. doi: 10.1186/s12875-026-03262-0 Search in PMC Search in PubMed View in NLM Catalog Add to search Hemoglobinometry at the point of care with activation of a hospital transfusion pathway versus usual care for the early detection of anaemia in primary care: the ANHEMOG randomized controlled trial Boris Trenado-Luengo Boris Trenado-Luengo 1 Centre d’Atenció Primària Badalona El Gorg, GAPiC BNM. Institut Català de la Salut, Badalona, Spain 2 Multidisciplinary Research Group in Health and Society GREMSAS (2021 SGR 01484), Mataró, Spain Find articles by Boris Trenado-Luengo 1, 2 , Rosa García-Sierra Rosa García-Sierra 3 Research Support Unit Metropolitana Nord, Primary care Research Institut Jordi Gol (IDIAPJGol), Mataró, Spain 4 Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain Find articles by Rosa García-Sierra 3, 4, ✉ , Maria Asunción Wilke Trinxant Maria Asunción Wilke Trinxant 2 Multidisciplinary Research Group in Health and Society GREMSAS (2021 SGR 01484), Mataró, Spain 5 Centre d’Atenció Primària Badalona Bufalà-Canyet. GAPiC BNM, Institut Català de la Salut, Badalona, Spain Find articles by Maria Asunción Wilke Trinxant 2, 5 , Esther Díaz Mondelo Esther Díaz Mondelo 6 Centre d’Atenció Primària Badalona Centre-Dalt de la Vila. GAPiC BNM, Institut Català de la Salut, Badalona, Spain Find articles by Esther Díaz Mondelo 6 , Pere Toran-Monserrat Pere Toran-Monserrat 3 Research Support Unit Metropolitana Nord, Primary care Research Institut Jordi Gol (IDIAPJGol), Mataró, Spain 7 Department of Medicine, Faculty of Medicine, Universitat de Girona, Girona, Spain Find articles by Pere Toran-Monserrat 3, 7 Author information Article notes Copyright and License information 1 Centre d’Atenció Primària Badalona El Gorg, GAPiC BNM. Institut Català de la Salut, Badalona, Spain 2 Multidisciplinary Research Group in Health and Society GREMSAS (2021 SGR 01484), Mataró, Spain 3 Research Support Unit Metropolitana Nord, Primary care Research Institut Jordi Gol (IDIAPJGol), Mataró, Spain 4 Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain 5 Centre d’Atenció Primària Badalona Bufalà-Canyet. GAPiC BNM, Institut Català de la Salut, Badalona, Spain 6 Centre d’Atenció Primària Badalona Centre-Dalt de la Vila. GAPiC BNM, Institut Català de la Salut, Badalona, Spain 7 Department of Medicine, Faculty of Medicine, Universitat de Girona, Girona, Spain ✉ Corresponding author. Received 2024 Nov 18; Accepted 2026 Mar 4; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13085367 PMID: 41808002 Abstract Background Anaemia is a common condition associated with increased morbidity, mortality, and health resource utilization. Early detection and timely treatment are essential to improve prognosis and quality of life. The aim of this study was to evaluate the effect of point-of-care haemoglobinometry combined with activation of a hospital transfusion circuit compared with usual care in patients with transfusion-dependent chronic anaemia managed in primary care settings in Catalonia, Spain. Methods A randomized controlled clinical trial was conducted between 2018 and 2021 in primary care centres of the Catalan Institute of Health. Patients were randomly assigned to an intervention group (monthly capillary haemoglobin monitoring using a haemoglobinometer and activation of a transfusion circuit) or a control group (standard venous blood monitoring according to usual practice). Descriptive statistics were calculated, and between-group comparisons were performed using appropriate statistical tests. Results Patients in the intervention group had shorter hospital stay (median = 2 vs. 12.5 days; p = 0.319), although these differences were not statistically significant. Median values of emergency room visits were significantly lower in the intervention group (1) compared to the control group (4), p < 0.001, as was total emergency room time in hours (4 vs. 70; p < 0.001). At 12 months, quality of life scores were significantly higher in the intervention group (15 vs. -2; p < 0.001). Conclusions Point-of-care haemoglobinometry combined with an organized transfusion circuit improves quality of life and reduces emergency service utilization in patients with transfusion-dependent anaemia, with important implications for clinical practice and healthcare resource optimization. Trial registration ClinicalTrials.gov NCT04757909 . Submitted February 16, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-026-03262-0. Keywords: Anaemia, Haemoglobinometry, Point-of-care testing, Red blood cell transfusion, Primary care, Randomized controlled trial Background Anaemia remains a very common condition, affecting one third of the world’s population [ 1 ] and its prevalence, according to WHO criteria, is around 24.3% in the general population [ 2 ] and 2.8% among subjects over 60 years of age [ 3 ]. Anaemia is a significant global health problem that requires a suitable approach [ 1 ], since it is associated with worse overall survival, disability [ 2 ] and is an independent risk for health-related quality of life in individuals over 60 years of age compared to younger individuals [ 3 ]. Furthermore, anaemia is a known risk factor for postoperative morbidity and mortality in some surgeries [ 4 ], and other chronic diseases. In the specific case of sickle cell anaemia, although life expectancy is improving, it is still lower than that of the general population. On the other hand, patients with anaemia show several known predictors of mortality, such as cardio-respiratory dysfunction markers, renal failure and haemolysis. Identifying patients at high risk can help prioritize therapies for patients with anaemia [ 5 ]. In patients with heart failure, anaemia is a frequent comorbidity that worsens their prognosis and functional capacity [ 6 ]. Intravenous iron replacement has been shown to improve exercise capacity and quality of life in these patients, as well as reduce the risk of hospitalization due to heart failure [ 7 ]. In the context of chronic obstructive pulmonary disease (COPD), anaemia is associated with an increased risk of hospital readmission and mortality, as well as lower functional capacity [ 8 ]. Furthermore, in patients who are critically ill with COPD, the presence of anaemia could be associated with a worse prognosis [ 9 ]. In elderly patients, anaemia is an independent risk factor for a number of adverse outcomes, including hospitalization, morbidity, and mortality [ 10 , 11 ]. Low haemoglobin levels are associated with poorer quality of life and increased risk of frailty in older adults who live in the community [ 12 ]. In summary, anaemia is a common condition affecting a large part of the world’s population and is associated with a variety of health problems, including increased morbidity, disability and mortality in various medical conditions. Its satisfactory diagnosis and treatment are fundamental in order to improve quality of life and reduce associated risks. Therefore, the objective of this study was to evaluate the impact of early detection of anaemia using point-of-care haemoglobinometry combined with activation of a hospital transfusion circuit, compared with usual care, on healthcare utilization, quality of life, and patient outcomes in individuals with transfusion-dependent chronic anaemia managed in primary care. Methods General aim To assess the impact of point-of-care haemoglobinometry and an organized hospital transfusion circuit on healthcare utilization, quality of life, and patient satisfaction in individuals with transfusion-dependent chronic anaemia managed in primary care. Specific aims: Compare the number of hospital admissions of patients monitored by HGB with the usual practice of venipuncture monitoring. Compare the number of visits to hospital emergency rooms by patients monitored using HGB and those monitored routinely using venipuncture. Compare the change in quality of life of patients being monitored with HGB and patients with routine venipuncture monitoring. Compare the satisfaction of patients being monitored by HGB with patients monitored by venipuncture. Eligibility criteria Eligible participants were adults diagnosed with chronic anaemia requiring periodic transfusion, with no curative treatment available for the underlying condition. Patients receiving palliative care or those who declined participation were excluded. Data collection and analysis The Case Manager Nurse received specific training in the use of the haemoglobinometer prior to study initiation. In the intervention group, anaemia monitoring was conducted using monthly capillary blood measurements, whereas in the control group monitoring was based on standard venous blood extraction according to routine clinical practice. Quality assurance and confidentiality Data were anonymized, securely stored, and accessible only to authorized researchers. Random selection of participants minimized selection bias, and periodic monitoring ensured protocol adherence. Design Randomized controlled clinical trial. Scope of study Primary Care Centres of the Catalan Institute of Health (ICS) in the territorial areas of Santa Coloma de Gramanet, Badalona and Mataró (Barcelona, Spain) (Table 1 ). Table 1. Patient eligibility criteria Inclusion criteria Exclusion criteria People over 40 years old Renal failure undergoing hemodialysis treatment Have received two or more transfusions of concentrated red blood cells for chronic pathology during the past year Undergoing palliative care The health provider is the Catalan Health Institute Moderate-severe cognitive impairment (Pfeiffer score greater than 5 and without a caregiver) Open in a new tab The study procedure is explained in the flowchart of the Consolidated Standards of Reporting Clinical Trials (CONSORT) (Fig. 1 ) (CONSORT, n.d.). Fig. 1. Open in a new tab Consolidated standards of reporting clinical trials flowchart (CONSORT) Sample size A priori sample size calculation was conducted based on an alpha risk of 0.05 in a two-sided test and an expected clinically relevant difference. Despite this planning, the target sample size could not be achieved due to recruitment difficulties. The final sample included 22 participants in the experimental group and 17 in the control group. A post hoc power analysis based on the observed results suggested high power. Allocation of interventions Patients were randomly assigned to either the control or intervention group based on a computer-generated random number list, as they were identified. Data collection, management and analysis Data collection in the intervention group was carried out during face-to-face visits. A Case Manager Nurse monitored Hb using the HGB, and also recorded clinical variables (blood pressure, heart rate, respiratory rate, etc.) as well as the treatments currently being followed by the participant. Data collection in the control group was carried out through twice-monthly telephone calls and the same variables were collected. The blood sample for Hb control in this group was taken according to standard practice (intravenously at home or at the health centre and sent to the reference laboratory for analysis). All variables were recorded in a data collection dossier. The complete ad hoc questionnaire is provided in Supplementary Material 1. The WHOQOL-BREF [ 13 ] quality of life survey was administered during the initial visit, during the six-month visit and during the twelve-month visit (end of study). Intervention All study participants had to be accurately diagnosed with the anaemia requiring transfusion prior to their group assignment, and must have had no curative treatment options for the underlying causes of these anaemias requiring transfusion. Furthermore, the interventions to be performed, as well as the lower limit value of Hb for transfusion, were agreed upon with the doctor in charge of the patient, the patient and their family. This transfusion methodology is called “liberal” and has been shown to be safer than transfusions based on standardized Hb values, resulting in fewer adverse effects and lower mortality [ 14 ]. Participants in the intervention group underwent Hb and Hc measurements with HGB Veri-Q Red ® [ 15 ], on a monthly basis. When the Haemoglobin (Hb) value was below the reference value for each patient, the Case Manager Nurse activated the transfusion circuit. An urgent referral to the outpatient service of the reference hospital where transfusions are performed on an outpatient basis was scheduled. The interdisciplinary team for said device performed the transfusion and the patient was discharged home. The HGB Veri-Q Red ® is a device that determines Hb and Hc values using capillary blood. A puncture is made in the pad of a finger and blood is obtained using a pipette, then it is deposited on the test strip that is introduced into the HGB and the results are obtained in five seconds. This device is CE tested and approved. Additionally, a concordance study in real-world practice was conducted, yielding optimal results for its use by professionals without prior experience in the technique [ 16 ]. During the initial visit, at 6 months and at 12 months, the WHOQOL-BREF quality of life questionnaire [ 13 , 17 , 18 ] was administered to both groups. This questionnaire is the short version of the WHOQOL 100 [ 13 ]. It consists of four domains that are independently assessed for quality of life: Physical health, psychological health, social relationships and environment. The assessment of physical health includes daily activities, medications, technical aids, energy and fatigue, mobility, pain and discomfort, ability to work, and walking on flat ground and uphill. Regarding physical health, the assessment includes activities of daily living, medications, technical aids, energy and fatigue, mobility, pain and discomfort, ability to work, walking on flat ground and uphill. The social relationships domain values personal relationships, social support, and sexual activity. Finally, the environmental domain assesses economic resources, freedom, physical security, health and social care, home environment, skills for participating and acquiring new information, recreational activities, and environmental pollution. Whenever possible, the WHOQOL-BREF questionnaire should be self-administered. The score for each item has a range of 1 to 5, with 1 being Very Dissatisfied and 5 being Very Satisfied. Once the questionnaire has been answered, the scores for each domain are added together; the higher the result, the greater the quality of life perceived by the patient. Scores can be expressed by domain or the results from all domains can be added together to obtain a final score. The total score ranges from 26 to 130 points. Control group (usual care) Participants in the control group received standard venous blood monitoring and routine clinical follow-up. Activation of the transfusion circuit occurred when haemoglobin values fell below individualized thresholds. Control group participants will receive twice-monthly telephone calls to record hospital admissions and emergency room visits during the study period. The WHOQOL-BREF quality of life questionnaire will be administered during the first visit, and at six and twelve months after inclusion in the study. To complete the collection of variables of the control group, the patient’s computerized medical history was consulted. These patients had their anaemia monitored using the usual procedure of extracting venous blood. When the Hb value was below the reference value for each patient, the Case Manager Nurse activated the transfusion circuit described above. Criteria for interrupting or modifying interventions assigned to each subject in the trial Participants were excluded from the trial if: Death occurred. The patient expressed a desire to withdraw from the trial. The person started palliative care. During the trial, capillary Hb monitoring was not permitted in patients in the control group. Statistical analysis The main numerical variables will be described using central tendency and dispersion statistics or absolute and relative frequencies in the case of categorical variables. Comparisons between the intervention group and the control group were conducted using non-parametric tests for comparing means of independent samples for continuous variables (Mann-Whitney U), due to the small size of the groups to be compared. For categorical variables chi-square test was used. Quality assurance and confidentiality To ensure diligence in the collection of quantitative data, the data were entered into a coded database, making it impossible to attribute the data to any individual without additional information. This information was recorded separately and subjected to technical measures to prevent data traceability. They were stored in a local repository that only researchers can access. Participants in each group were selected randomly to avoid selection bias. To improve compliance with intervention protocols, the trial monitor will prepare a follow-up report every six months, which will reflect whether the follow-up visits are being carried out and whether they are properly recorded in the data collection form. In parallel to the trial, if patients are detected and are not in the transfusion circuit, they will be included with the approval of professionals in the hospital and primary care settings. Results A total of 39 participants were recruited, of which 36% [ 14 ] were women, with a mean age of 81.02 (SD 5.58). In the intervention group, 22 individuals were recruited, with a mean age of 82.05, where 40% [ 9 ] were women (p0.518). There were 17 individuals in the control group, with a mean age of 80.41 while 29.4% [ 5 ] were women ( p 0.067). Heterogeneity was observed for the two groups regarding the diagnosis of anaemia ( p 0.712). In the intervention group, 54.5% [ 12 ] had iron deficiency anaemia, 27.3% [ 6 ] had unspecified anaemia, 9.1% [ 2 ] had anaemia due to chronic disease, and 9.1% [ 2 ] had macrocytic anaemia. It was observed that a higher percentage of patients in the control group were included in case management (70.6%, 12 patients) compared to those in the intervention group (40.9%, 9 patients). No heterogeneity was observed in patient complexity (p0.42). It was found that 32% [ 8 ] in the intervention group were Complex Chronic Patients (CCP) and 16% [ 4 ] were patients with Advanced Chronic Disease (ACD). Unlike the control group where 35% were CCP and 30% [ 6 ] were ACD patients. Regarding cognitive state, 72.7% [ 16 ] of the patients in the intervention group had a normal Pfeiffer score, 18.2% [ 4 ] had mild cognitive deterioration, and 9.1% [ 2 ] had moderate cognitive deterioration. In the control group, 94.1% of the patients [ 16 ] had a normal Pfeiffer and 5.9% [ 1 ] had moderate cognitive impairment (Table 2 ). Table 2. Sample description and initial comparison of groups. Categorical variables. N = 39 Total sample n (%) Experimental ( n = 22) n (%) Control ( n = 17) n (%) X 2 p Female 14 (36) 9 (40.9) 5 (29.4) 0.551 0.518 Type of anaemia 2.13 0.712 Iron deficiency anaemia 20 (51.3) 12 (54.5) 8 (47.1) Unspecified anaemia 10 (25.6) 6 (27.3) 4 (23.5) Due to chronic disease 5 (12.8) 2 (9.1) 3 (17.6) Macrocytic anaemia 3 (7.7) 2 (9.1) 1 (5.9) Complexity Not complex 18 (46.2) 13 (52) 7 (35) 1.733 0.42 CCP 14 (36) 8 (32) 7 (35) Advanced Chronic Disease 7 (17.9) 4 (16) 6 (30) Case management Yes 18 (46.2) 9 (40.9) 12 (70.6) 3.399 0.106 No 21 (53.8) 13 (59.1) 5 (29.4) Pfeiffer Normal 32 (82.1) 16 (72.7) 16 (94.1) 3.754 0.153 Slight deterioration 4 (10.3) 4 (18.2) 0 Moderate deterioration 3 (7.7) 2 (9.1) 1 (5.9) Open in a new tab Heterogeneity was observed in the number of pathologies between the groups, but it did not reach statistical significance ( p = 0.604). Patients in the intervention group had a median of 4 chronic diseases (IQR 3.5-5), while patients in control group had a median of 4 chronic diseases (IQR 3.5–5.75). Regarding the quality of life of the participants, at the beginning of the study, participants in the intervention group had a similar perception of quality of life (65 points, IQR 62.5–73.5) compared to the control group (64 points, IQR 60.25–75.25) ( p = 0.834) (Table 3 ). Table 3. Sample description and initial comparison of groups. Continuous variables. N = 39 Median(IQR) Experimental ( n = 22) Median(IQR) Control ( n = 17) Median(IQR) Mann-Whitney U p Age 82 (78–84) 84 (75–85) 80 (78.25–83.5) 251.5.500 0.067 Initial quality of life 65 (64.5–73.5) 65 (62.5–73.5) 64 (60.25–75.25) 194.500 0.834 Number of pathologies 4 (3–5) 4 (3.5-5) 4 (3-5.75) 205.500 0.604 Open in a new tab Data are presented as median (interquartile range) Baseline demographic and clinical characteristics of participants are presented in Tables 2 and 3 . No statistically significant differences were observed between groups regarding demographic and clinical characteristics. Regarding resource consumption, it was observed that patients in the intervention group and control group visited hospital a median of 1 (IQR 0–1) times per year ( p 0.547). The median length of hospital stay for patients in the intervention group was 2 (IQR 0–10) days per admission, compared to 12.5 (IQR 0-38.5) days per admission for the control group (p 0.319). Regarding emergency room visits, it was seen that the patients in the intervention group went to the emergency room a median of 1 times per year, unlike the patients in the control group, which went to the emergency room a median of 4 times ( p < 0.001). For the time they stayed in the emergency room, the intervention group the median was 4 h, while the control group spent a median of 70 h ( p > 0.001). Furthermore, the circuit activation time for the intervention group was 0.2 h while the control group activation time was 55.5 h ( p < 0.001). The quality of life at 6 months between the two groups was + 6 points in the intervention group and − 2 points in the control group. The difference increased at the 12 month point of the study. The intervention group gained 15 points with respect to the previous quality of life while the control group obtained − 2 points of quality of life with respect to the 6 month point of the study ( p < 0.001) (Table 4 ). Table 4. Patient outcomes and comparison of groups. N = 39 Total sample Median(IQR) Experimental ( n = 22) Median(IQR) Control ( n = 17) Median(IQR) Mann-Whitney U p Number of hospital admissions 1 (0–1) 1 (0–1) 1 (0–1) 165.000 0.547 Duration of hospital admission 3 (0–20) 2 (0–10) 12.5 (0-38.5) 151.500 0.319 Number of emergency room visits 1 (1–4) 1 (0–1) 4 (2-7.75) 40.500 < 0.001 Total time in emergency room 12 (4-53.5) 4 (0–12) 70 (14.5–118) 37.500 < 0.001 Day hospital visits 2 (0-3.5) 1(0–4) 2 (1–3) 186.000 0.989 Time for activation of control visit* 0.5 (0–45) 0.2 (0-0.5) 55.5 (13.5-113.5) 54.000 < 0.001 Scheduled ambulances 5 (2–7) 2 (0–4) 7.50 (5-10.75) 7.50 < 0.001 Emergency ambulances 1(0–3) 0 (0–1) 2.50 (0-4.75) 114.000 < 0.001 Change of quality of life at 6 months 2 (-2.5-10.5) 6 (2-17.5) -2 (-4-0) 364.5 < 0.001 Change of quality of life at 12 months 2 (-3-15.5) 15 (9–19) -2 (-7.5-0) 374.0 < 0.001 Open in a new tab * Time in hours Data are presented as median (interquartile range) Discussion Anaemia has a major impact on the individual who suffers from it, their family, their environment and the healthcare system. The aim of this study was to evaluate the impact on patients and the healthcare system of implementing HGB monitoring in primary care in patients with chronic anaemia. Since people with severe anaemia increase the consumption of different health resources [ 19 – 22 ], the impact was assessed using different criteria. Firstly, since anaemia can contribute to the length of hospital stay due to several reasons [ 23 ], the length of hospital stay was assessed, observing a tendency towards a decrease, as well as in the number of admissions [ 23 ], but with no statistical significance. This result suggests that a delay in the treatment of anaemia contributes to a poor prognosis. The results of a study in patients with a left ventricular assist device point in the same direction, prognosis worsened when a diagnosis of anaemia was delayed [ 24 ]. Secondly, the number of visits to emergency services was calculated; the results of this study show a very striking decrease from an average of 4.94 in the control group to 0.91 in the intervention group. Regarding the total time spent in the emergency room, a large decrease is also observed, with both parameters showing statistical differences of less than 0.001. Visits to the day hospital facilities were also calculated, a variable on which the intervention had no impact. The third health resource evaluated was medical transport. As observed, patients in the control group required more rides to the hospital for transfusions, with the inconvenience that this causes to the patient and the family, in addition to the impact on resource consumption. In the case of the intervention group, in addition to the rapid diagnosis of anaemia detection, with the planning of monthly visits, the schedules were further adapted to the needs of the patient and their family, thus reducing the inconvenience for both. Addressing this issue requires better care management and the introduction of new treatment options [ 2 , 20 ] to address delays between diagnosis and treatment, and high rates of hospitalization and emergency department use among patients with severe anaemia [ 21 , 22 ]. Finally, the impact on the patient’s quality of life was evaluated. The results of the control group show a deterioration in quality of life at 6 months, which worsens at twelve months. The results of the control group, however, show an improvement of 11 and 16 points respectively. These results therefore show a great positive impact on the quality of life of these patients, which, as multiple studies conclude, is currently very low [ 25 – 28 ] . This study highlights the need to develop an individualized plan for each patient who requires periodic transfusions, as it improves decision-making and rapid response. This was suggested in the meta-analysis by the working group, who developed ten recommendations for the management of anaemia in patients with gastrointestinal bleeding. The study concludes that these recommendations can serve as a starting point for physicians to diagnose and treat anaemia in patients with gastrointestinal bleeding, as it can improve health outcomes in these patients [ 29 ]. Counselling, empowerment, and improving physician-patient communication are important strategies to improve health care delivery and, consequently, quality of life among adults with anaemia [ 27 ]. On the other hand, as the literature suggests, the objective must be aimed at controlling the underlying disease and correcting the anaemia [ 30 ]. In our study, transfusion was the objective, i.e., to control the anaemia of the participants through transfusions. The liberal method was used to perform transfusions, individualizing each case, as suggested in the literature, since this transfusion methodology was associated with a higher quality of life [ 14 ]. Monitoring and controlling severe anaemia is essential, and our study reveals that patients who undergo closer monitoring through early diagnosis of anaemia improve their quality of life. This intervention could also improve depressive symptoms, complications such as repetitive infections, pain, and low adherence to medication, as suggested by the literature [ 31 ]. As can be seen in our study, 32% of the participants were Complex Chronic Patients. This indicates that severe anaemia is a determining factor in the prevalence of the complexity or vulnerability of patients, and haemoglobin levels are a determining factor in the quality of life of these patients [ 25 ]. In our study, the average age of the patients included was 81.02 years, an aspect that makes it difficult to address severe anaemia since, as reported in other studies, the diagnosis and treatments of these conditions in the elderly differ from those of other age groups [ 32 ]. Patients with severe anaemia consume a high level of healthcare resources [ 19 – 22 ]. Addressing this issue requires better care management and the introduction of new treatment options [ 20 ], as well as addressing the delay between diagnosis and treatment, high rates of hospitalization and emergency services use among patients with severe anaemia [ 21 , 22 ]. Anaemia may contribute to the length of stay in hospital for several reasons [ 23 ]. With the introduction of a haemoglobinometer and the creation of a transfusion circuit for the early diagnosis and treatment of patients with periodic anaemia, a significant reduction in hospital time stays of almost 40% was observed. Furthermore, a 24% reduction in emergency room visits were also observed. This highlights that this intervention in patients with severe anaemia has a positive impact on the resource consumption by these patients. The limitations we observed in this study were the recruitment of patients. Since the patient profile was very specific and the study area was very limited, detection and inclusion in the study was slow and complex. Furthermore, difficulties were observed in the coordination between primary care and hospital care, in terms of the activation of the transfusion circuit. This aspect highlights the presence of a fragmentation of the health system. From a clinical perspective, the integration of point-of-care haemoglobinometry into primary care nursing practice facilitates earlier decision-making and improved coordination with hospital services. At a policy level, structured transfusion circuits may contribute to more efficient use of healthcare resources. Future multicentre studies with larger samples are needed to confirm these findings and to assess long-term cost-effectiveness. Conclusions The introduction of an HGB and a transfusion circuit in the monitoring and early detection of anaemia in patients requiring transfusion improves their prognosis, quality of life and the use of health resources. Participants who underwent HGB monitoring had fewer hospital admissions, although reductions in hospital admissions did not reach statistical significance, likely due to the limited sample size, the observed improvements in emergency service utilization and quality of life highlight the clinical relevance of this intervention. Supplementary Information Supplementary Material 1. (89.7KB, pdf) Abbreviations HGB Haemoglobinometer Hb Haemoglobin Hc Haematocrit CAP Primary Care Centre Authors’ contributions **BTL** is the principal investigator and has developed the protocol and the manuscript. **AWT** contributed to the writing of this manuscript and to the creation of the participant profile. **RGS** was in charge of the data analysis section, determining the instruments to be used to explore the variables, and was the internal reviewer of this manuscript. **EDM** was responsible for preparing the tables and figures and contributed to the selection of variables for this study. **RMB** contributed to the writing of this manuscript and to the description of the objectives of this trial. **MLB** collaborated on the development of the protocol and in its dissemination and application in the Barcelonés Nord i Maresme area. **PMA** contributed to the writing of this manuscript. **PTM** contributed to the creation of the study hypothesis, to its conceptualization and design, and to the writing of the manuscript. **All authors have read and approved the final manuscript. **. Funding 1. Economic funding. Funding of innovation projects in Primary Health Care services of the ICS. IDIAP Jordi Gol. 2016 (€14,000). 2. Funding during working hours. 2nd Call for Research Grants from the Metropolitan North Primary Care Directorate. 2018 (90 horas). 3. Economic funding. Nursing Research Funding. Academy of Medical Sciences, Maresme branch. 2018 (€3,000). Data availability - The datasets used and/or analysed during the present study are available from the corresponding author upon reasonable request.- The datasets generated and/or analysed during the current study are not publicly available, as they were recorded manually in paper Data Collection Notebooks (DCNs) and are archived and kept by the Principal Investigator, until their destruction within ten years of acceptance by the Ethics Committee. They are available from the author upon reasonable request. Declarations Ethics approval and consent for participation Approval was obtained from the Ethics and Research Committee of IDIAP Jordi Gol where the study was conducted (number P17/159) on 11/12/2017. Participants were informed of the purpose of the study and how their participation would contribute to data collection. Willingness to participate was expressed verbally and an informed consent form (IC) was signed. The anonymity and confidentiality of the data was ensured in accordance with the provisions of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April on Data Protection (GDPR) and Organic Law 3/2018, of 5 December, on data protection and guarantee of digital rights. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. 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(89.7KB, pdf) Data Availability Statement - The datasets used and/or analysed during the present study are available from the corresponding author upon reasonable request.- The datasets generated and/or analysed during the current study are not publicly available, as they were recorded manually in paper Data Collection Notebooks (DCNs) and are archived and kept by the Principal Investigator, until their destruction within ten years of acceptance by the Ethics Committee. They are available from the author upon reasonable request. 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