Blunted erythropoietic response to anemia in multiply traumatized patients.
OBJECTIVE
To assess the relations between anemia, serum erythropoietin (EPO), iron status, and inflammatory mediators in multiply traumatized patients.


METHODS
Prospective observational study.


METHODS
Intensive care unit.


METHODS
Twenty-three patients suffering from severe trauma (injury severity score > or =30).


METHODS
None.


RESULTS
Blood samples were collected within 12 hrs after the accident (day 1) and in the morning on days 2, 4, 6, and 9 to determine blood cell status, serum EPO, tumor necrosis factor-alpha (TNF-alpha), soluble tumor necrosis factor-receptor I (sTNF-rI), interleukin-1 receptor antagonist (IL1-ra), interleukin-6 (IL-6), neopterin, and iron status, respectively. Hemoglobin concentration was low at admission (mean, 10.0 g/dL; range, 6.8-12.9 g/dL) and did not increase during the observation time. Serum EPO concentration was 49.8 U/L (mean value) on day 1 and did not show significant increases thereafter. No correlation was found between EPO and hemoglobin concentrations. TNF-alpha remained within the normal range. sTNF-rI was high at admission and increased further. IL1-ra was above the normal range. IL-6 was very high at admission and did not decrease thereafter. The initial neopterin concentration was normal, but increased until day 9. Serum iron was significantly decreased on day 2 posttrauma and remained low during the study. Serum ferritin increased steadily from day 2, reaching its maximum on day 9. In contrast, concentrations of transferrin were low from admission onward.


CONCLUSIONS
Multiply traumatized patients exhibit an inadequate EPO response to low hemoglobin concentrations. Thus, anemia in severe trauma is the result of a complex network of bleeding, blunted EPO response to low hemoglobin concentrations, inflammatory mediators, and a hypoferremic state.
Hobisch-Hagen
P
P
Division for General and Surgical Intensive Care Medicine, Clinic for Anesthesia and Intensive Care Medicine, The Leopold Franzens University Innsbruck, Innsbruck, Austria.
Wiedermann
F
F
Mayr
A
A
Fries
D
D
Jelkmann
W
W
Fuchs
D
D
Hasibeder
W
W
Mutz
N
N
Klingler
A
A
Schobersberger
W
W
D000328:Adult; D000740:Anemia / Q000209:etiology*; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D006454:Hemoglobins; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D007362:Intensive Care Units; D007501:Iron / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000150:complications*; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D006454:Hemoglobins; D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha; D004921:Erythropoietin; D007501:Iron