Indian J Crit Care Med 2007;11:173-5
Anemia is a common problem in critically ill patients.
[1] Adverse effects of anemia include increased risk of cardiac morbidity and mortality. In addition, the consequences of anemia may be compounded as critical illness increases metabolic demand.
Among the many causes of anemia in the critically ill, some of the most important are occult blood loss, including frequent blood sampling, shortening of red cell lifespan, inflammation / infection related hepcidin induced functional iron deficiency and decreased production of endogenous erythropoietin (EPO). One may be surprised to note that on an average, 40 ml of blood is drawn each day from a typical ICU patient. This is an important source of blood loss.
[2]
Impact of anemia on an ICU patient's morbidity and mortality, however, remains ill-defined. Similarly, the optimal hemoglobin (Hb) level also remains ill defined.
[3]
Anemia is typically treated with red cell transfusions. This is to maintain adequate oxygen delivery. Groeger
et al,
[4] found that 16% of patients in medical ICUs and 27% of those in surgical ICUs are transfused on any given day. In an analysis in the US, 85% of patients with an ICU stay of greater than one week, received at least one red cell transfusion. The mean number of units of red cell transfused per patients were 9.5.
[3]
The trigger for red cell transfusion in ICU remain ill-defined and has been the subject of considerable debate in recent years.
[5] Concerns and doubts have emerged regarding the benefits and safety of red cell transfusion, in part due to the lack of evidence of better outcome and in part related to increased risk of infection and other adverse effects. As a result of these concerns and also in view of several studies (vide infra) suggesting better or similar outcomes with a lower transfusion trigger, there has been a general tendency to decrease the transfusion threshold from the classic 10 g/dl to lower values.
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