When people come to the emergency room with low blood counts, doctors sometimes give them blood transfusions without first checking if the problem is caused by missing nutrients like iron or vitamin B12. A study of 198 patients found that only 29% received complete nutrient testing before their transfusion, while 39% got no testing at all. Iron deficiency was the most common fixable cause, but many patients didn’t get tested for it. The researchers say emergency rooms should do these simple, inexpensive blood tests first because fixing nutrient problems might prevent unnecessary transfusions.

The Quick Take

  • What they studied: Whether emergency room doctors tested patients for nutrient deficiencies (like low iron or vitamin B12) before giving them blood transfusions
  • Who participated: 198 adult patients who received their first blood transfusion in the emergency department at a large hospital in South Africa between April and October 2023
  • Key finding: Only 29% of patients got complete nutrient testing, 39% got no testing at all, and iron deficiency was the most common treatable cause—yet many patients without iron deficiency still received iron supplements
  • What it means for you: If you go to the emergency room with low blood counts, ask your doctor if they’ve tested you for nutrient deficiencies before recommending a transfusion, as these are often fixable with supplements instead

The Research Details

Researchers looked back at medical records from 198 patients who received blood transfusions in an emergency room over a 7-month period. They checked which patients had been tested for three common nutrient deficiencies—iron, vitamin B12, and folate—before getting their transfusion. They also looked at blood test results that show red blood cell size, which can hint at what type of deficiency a patient might have. The study was done at Groote Schuur Hospital in South Africa, a large teaching hospital that serves many patients.

This type of study is called a ‘cross-sectional’ study, which means researchers took a snapshot of what happened during one time period rather than following patients over years. They weren’t trying to prove that nutrient testing would prevent transfusions—they were simply documenting whether testing was actually being done and what the results showed.

The researchers used three different methods that the hospital commonly uses to check for iron deficiency, since there’s no single perfect test. They also tracked whether patients received supplements and what kind.

This research matters because nutrient deficiencies are common, easy to fix with supplements, and much cheaper and safer than blood transfusions. Blood transfusions carry small risks of infection and immune reactions. If doctors can identify and treat the real cause of low blood counts quickly, patients might avoid transfusions altogether. The emergency room is the perfect place to do this screening because that’s often when patients first seek help for their symptoms.

This study has some strengths: it looked at real patient data from a real hospital, used a large sample size (198 patients), and examined actual medical practices. However, it’s limited because it only looked at one hospital in one country during a short time period, so results might be different elsewhere. The study couldn’t prove that better testing would actually reduce transfusions—it only showed that testing wasn’t being done consistently. The researchers couldn’t control for all the reasons doctors might have skipped testing in individual cases.

What the Results Show

The study found a major gap in nutrient testing. Only 29% of patients received complete testing for all three nutrient deficiencies (iron, B12, and folate), while 39% received no nutrient testing at all. The remaining 32% got partial testing. This is concerning because nutrient deficiencies are common causes of low blood counts that can be treated with inexpensive supplements.

Iron deficiency was the most frequently found problem, appearing in many patients. Interestingly, up to 30% of patients with iron deficiency had normal-looking red blood cells on their tests, which means doctors might miss iron deficiency if they only look at red blood cell size. This is important because some doctors skip nutrient testing if red blood cells look normal-sized.

The study also found that many patients received iron supplements even though they didn’t have iron deficiency, suggesting doctors were treating without confirming the diagnosis. This wastes money and might not help the patient. On the flip side, some patients with confirmed iron deficiency didn’t receive supplements, meaning they missed a simple treatment opportunity.

The research showed that the method used to check for iron deficiency matters. Different testing approaches gave different results, which explains why some patients might be diagnosed differently depending on which test the doctor uses. The study also revealed that supplementation decisions didn’t always match test results—some patients got supplements they didn’t need while others with confirmed deficiencies didn’t get treated. This inconsistency suggests doctors weren’t using a clear, evidence-based approach to nutrient testing and treatment.

This study supports what other research has shown: nutrient deficiencies are common causes of low blood counts that are often overlooked in emergency settings. Previous studies have recommended that doctors use ‘patient blood management’ principles, which means trying to understand and treat the cause of low blood counts rather than automatically giving transfusions. This research adds to that evidence by showing that even basic screening tests aren’t being done consistently, which is a missed opportunity for better patient care.

This study only looked at one hospital in South Africa, so the results might not apply everywhere. It only examined a 7-month period, so seasonal patterns or changes over time weren’t captured. The study couldn’t explain why doctors made certain decisions—researchers could only see what was documented in medical records. They couldn’t prove that better nutrient testing would actually reduce transfusions, only that testing wasn’t being done. Finally, the study didn’t follow patients after their emergency room visit to see if they recovered better with or without transfusions.

The Bottom Line

If you’re in the emergency room with low blood counts, ask your doctor: (1) Have you tested me for iron, vitamin B12, and folate deficiency? (2) What are my results? (3) Can we treat the underlying cause before considering a transfusion? These tests are simple, inexpensive, and can guide better treatment. Confidence level: High—nutrient deficiencies are well-established, treatable causes of low blood counts.

Anyone experiencing fatigue, weakness, or shortness of breath should care about this. If you’re going to the emergency room with these symptoms, this research suggests you should advocate for nutrient testing. People with chronic conditions, dietary restrictions, or digestive problems are at higher risk for nutrient deficiencies. However, this doesn’t mean you should refuse a transfusion if your doctor recommends one—the point is to ensure proper testing happens first to guide the best decision.

If nutrient deficiency is the cause, supplements typically start improving symptoms within 2-4 weeks, though full recovery can take 2-3 months depending on severity. Blood transfusions work immediately but are meant for acute situations. The key is identifying the root cause so you get the right treatment.

Want to Apply This Research?

  • Track your energy levels and symptoms daily using a 1-10 scale before and after any nutrient supplementation. Note which nutrients you’re taking (iron, B12, folate) and dosages. This helps you and your doctor see if supplements are actually helping.
  • If you’ve been told you have low blood counts, use the app to set reminders for nutrient supplement doses and log when you take them. Create a summary of your test results to share with doctors at future appointments, ensuring continuity of care and preventing repeated unnecessary testing.
  • Set monthly check-ins to review energy levels, symptoms, and supplement adherence. If using the app’s health tracking feature, compare your baseline symptoms to current status. Schedule follow-up blood work reminders at the intervals your doctor recommends (typically 4-8 weeks after starting supplements) to confirm improvement.

This research describes current medical practices at one hospital and does not constitute medical advice. Blood transfusions are sometimes necessary and life-saving. Never refuse a transfusion recommended by your emergency room doctor without discussing alternatives first. If you have concerns about whether nutrient testing was done before a transfusion, discuss this with your doctor or seek a second opinion from a hematologist (blood specialist). This information is educational and should not replace professional medical judgment. Always consult with your healthcare provider about your individual situation.