title: Anemia and blood transfusion in the critically ill patient: role of erythropoietin.
abstract: Critically ill patients receive an extraordinarily large number of blood transfusions. Between 40% and 50% of all patients admitted to intensive care units receive at least 1 red blood cell (RBC) unit during their stay, and the average is close to 5 RBC units. RBC transfusion is not risk free. There is little evidence that 'routine' transfusion of stored allogeneic RBCs is beneficial to critically ill patients. The efficacy of perioperative recombinant human erythropoietin (rHuEPO) has been demonstrated in a variety of elective surgical settings. Similarly, in critically ill patients with multiple organ failure, rHuEPO therapy will also stimulate erythropoiesis. In a randomized, placebo-controlled trial, therapy with rHuEPO resulted in a significant reduction in RBC transfusions. Despite receiving fewer RBC transfusions, patients in the rHuEPO group had a significantly greater increase in hematocrit. Strategies to increase the production of RBCs are complementary to other approaches to reduce blood loss in the intensive care unit, and they decrease the transfusion threshold in the management of all critically ill patients.
authors.affiliation: Dartmouth Medical School, Critical Care Medicine, Intensive Care Unit, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. Howard.L.Corwin@Hitchcock.org
authors.forename: Howard L
authors.initials: HL
authors.lastname: Corwin
mesh_terms: D000740:Anemia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D004921:Erythropoietin / Q000627:therapeutic use*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D009102:Multiple Organ Failure / Q000188:drug therapy* / Q000209:etiology; D018962:Phlebotomy / Q000009:adverse effects; D011994:Recombinant Proteins; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin