Anemia in Critical Illness

Hayden, Shailaja J.; Albert, Tyler J.; Watkins, Timothy R.; Swenson, Erik R.

doi:10.1164/rccm.201110-1915ci

Cited by 211 publications

(88 citation statements)

References 120 publications

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“…Anemia is highly prevalent in critically ill patients but the context in patients with AE remains unclear ( 18 ). A multitude of studies found that up to two-thirds of critically ill patients have a hemoglobin concentration <12 g/dl at ICU admission ( 19 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

et al. 2017

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BackgroundPrevention and early recognition of critical illness in patients with autoimmune encephalitis (AE) is essential to achieve better outcome.Aim of the studyTo evaluate risk factors for intensive care unit (ICU) admission and its prognostic impact in patients with AE.Patients and methodsA reclassification of patients hospitalized between 2011 and 2016 revealed 17 “definite” and 15 “probable” AE cases. Thirteen patients (41%) developed critical illness and required ICU admission. The underlying conditions were intractable seizures or status epilepticus (54%), altered mental state (39%), and respiratory failure (8%).ResultsICU admission was associated with longer time from first symptoms to hospitalization (p = 0.046). Regression analysis revealed that anemia on hospital admission and definite diagnosis of AE was associated with a higher risk of acquiring critical illness. At last follow-up after a median of 31 months (range 2.5–52.4), seven patients had died (23%) and 63% had a good outcome [modified Rankin Scale (mRS) 0–3]. Anemia was associated with poor prognosis (p = 0.021), whereas development of critical illness did not impact mortality and functional outcome.ConclusionWe confirmed the need for ICU care in a subgroup of patients and the prevailing objective is improved seizure control, and definite diagnosis of AE and anemia were identified as risk factors for development of critical illness. However, prognosis was not affected by ICU admission.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

et al. 2017

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“…This outcome is important because blood transfusion may be associated with worse outcome after oncologic surgery, including long-term survival (35-38). Blood transfusion is not harmless and has been associated with several clinical side effects, including transfusion related acute lung injury and fluid overload (39). In critically ill patients, blood transfusion is associated with poorer outcomes (39).…”

Section: Discussionmentioning

confidence: 99%

“…Blood transfusion is not harmless and has been associated with several clinical side effects, including transfusion related acute lung injury and fluid overload (39). In critically ill patients, blood transfusion is associated with poorer outcomes (39). …”

Section: Discussionmentioning

confidence: 99%

Effect of intraoperative HES 6% 130/0.4 on the need for blood transfusion after major oncologic surgery: a propensity-matched analysis

Zampieri¹,

Ranzani²,

Morato³

et al. 2013

Clinics

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OBJECTIVES:To evaluate the effect of the intraoperative use of hydroxyethyl starch on the need for blood products in the perioperative period of oncologic surgery. The secondary end-points included the need for other blood products, the clotting profile, the intensive care unit mortality and length of stay.METHODS:Retrospective observational analysis in a tertiary oncologic ICU in Brazil including 894 patients submitted to oncologic surgery for a two-year period from September 2007. Patients were grouped according to whether hydroxyethyl starch was used during surgery (hydroxyethyl starch and No-hydroxyethyl starch groups) and compared using a propensity score analysis. A total of 385 propensity-matched patients remained in the analysis (97 in the No-hydroxyethyl starch group and 288 in the hydroxyethyl starch group).RESULTS:A higher percentage of patients in the hydroxyethyl starch group required red blood cell transfusion during surgery (26% vs. 14%; p = 0.016) and in the first 24 hours after surgery (5% vs. 0%; p = 0.015) but not in the 24- to 48-hour period after the procedure. There was no difference regarding the transfusion of other blood products, intensive care unit mortality or length of stay.CONCLUSION:Hydroxyethyl starch use in the intraoperative period of major oncologic surgery is associated with an increase in red blood cell transfusions. There are no differences in the need for other blood products, intensive care unit length of stay or mortality.

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“…Critically ill patients, including those with sepsis, develop anaemia in up to 70% of cases, of which 44-50% will require a blood transfusion [16,17,18]. In septic patients, blood transfusion are required in up to 50% of cases due to a normocytic, normochromic anaemia with low iron, low transferrin but high ferritin, which usually develops through altered iron metabolism and erythropoiesis [17][18][19][20][21][22]. This is due to the inflammatory response stimulated by surgical sepsis and stress leading to elevated inflammatory markers, which inversely correlates with Hb levels [21,23,24].…”

Section: Pathophysiology Of Anaemia In Surgical Stress and Sepsismentioning

confidence: 99%

“…Rogiers et al showed that non-septic critically ill patients had a normal correlation between haematocrit and EPO levels, while septic patients developed more severe anaemia and had lower circulating EPO levels [20]. The inflammatory cytokines IFN-gamma, IL-1 and TNF-alpha have been implicated in the alteration of EPO production [19,25,26]. These inflammatory markers inhibit hypoxiainduced EPO production [25].…”

Section: Altered Erythropoiesismentioning

confidence: 99%

Anaemia in Surgical Sepsis and Stress: The Roles of Erythropoietin, Iron and Steroids

Smits¹,

Hart²,

Sivarajah³

et al. 2019

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Background: Inflammation in surgical sepsis and stress frequently causes anaemia, leading to increased rates of blood transfusions. Recent evidence shows that blood transfusions carry a greater risk for short-and longterm complications than previously thought. Objective: To review the role of erythropoietin (EPO), iron and/or steroids as an alternative treatment to blood transfusions in critically ill patients. Methodology: A systematic review was prepared from recent literature on inflammation-induced anaemia, anaemia in the critically ill and/or septic patient and the roles of EPO, iron and corticosteroids in these patients. A meta-analysis was completed for EPO. Results: Inflammatory cytokines alter haematopoietic and biochemical pathways, leading to anaemia. Inflammation decreases circulating EPO and upregulates hepcidin, resulting in decreased free iron. Twelve randomised-controlled trials demonstrate that EPO administration in critically ill patients reduces the need for blood transfusions by 31% (p=0.005) however does not significantly decrease mortality (p=0.15). Intravenous iron also reduces the need for blood transfusions but has not been utilised in sepsis-associated anaemia. No trials focusing on the effects of steroids on sepsis-associated anaemia were identified. Conclusion: Due to the lack of data specific to sepsis-associated anaemia in post-operative patients, the roles of EPO, iron and steroids remain under investigation. More research specific to surgical patients is needed.

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Anemia in Critical Illness

Cited by 211 publications

References 120 publications

Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

Risk Factors for Intensive Care Unit Admission in Patients with Autoimmune Encephalitis

Effect of intraoperative HES 6% 130/0.4 on the need for blood transfusion after major oncologic surgery: a propensity-matched analysis

Anaemia in Surgical Sepsis and Stress: The Roles of Erythropoietin, Iron and Steroids

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