Bed bugs are associated with anemia

Am J Emerg Med. 2021 Aug;46:482-488. doi: 10.1016/j.ajem.2020.10.070. Epub 2020 Nov 5.


Introduction: Bed bugs are hematophagous insects that can be problematic in some urban emergency departments. The objective was to determine if red blood cell (RBC) and coagulation indices of bed bug-infested emergency department (ED) patients differed from those of noninfested control patients.

Methods: A chart review from a single health system was performed for ED patients between February 1, 2011, and February 1, 2017. Bed bug-infested patients were matched to noninfested control patients on the basis of age, sex, and the presenting ED. Variables were analyzed with the t-test and Pearson χ2 test and were modeled with multivariable logistic regression.

Results: The study had 332 bed bug-infested patients and 4952 controls. Infested patients had lower hemoglobin (11.7 g/dL vs 12.8 g/dL), hematocrit (35.0% vs 37.9%), RBC counts (4.1 × 109/L vs 4.4 × 109/L), mean corpuscular volume (86.0 vs 87.5 fL/cell), and mean corpuscular hemoglobin concentrations (33.2 vs 33.7 g/dL) and higher RBC distribution width-coefficient of variation (RDW-CV) (15.2% vs 14.2%) than noninfested patients (all P ≤ .003). Infested patients were more likely to be anemic (59.5% vs 36.9%) and to have severe anemia (4.4% vs 0.7%) (P < .001 for both). Blood transfusions were more common in those with bed bugs (5.1%) than those without bed bugs (2.3%) (P < .001).

Conclusion: Bed bug infestated patients in the ED are associated with anemia.

Keywords: Anemia; Hematology; Infectious diseases; Iron deficiency; Public health.

MeSH terms

  • Adult
  • Aged
  • Anemia / blood
  • Anemia / epidemiology*
  • Animals
  • Bedbugs*
  • Ectoparasitic Infestations / blood
  • Ectoparasitic Infestations / epidemiology*
  • Emergency Service, Hospital
  • Erythrocyte Count
  • Erythrocyte Indices
  • Female
  • Hematocrit
  • Hematologic Tests
  • Hemoglobins / metabolism
  • Humans
  • International Normalized Ratio
  • Logistic Models
  • Male
  • Middle Aged
  • Partial Thromboplastin Time
  • Reticulocyte Count


  • Hemoglobins