Anemia of critical illness.
Anemia of critical illness, a commonly encountered clinical situation, is hematologically similar to that of chronic anemia, except that the onset is generally sudden. The etiology is usually multifactorial, occurring as a consequence of direct inhibitory effects of inflammatory cytokines, erythropoietin deficiency, blunted erythropoietic response, blood loss, nutritional deficiencies, and renal insufficiency. Although anemia is not well tolerated by critically ill patients, aggressive treatment of anemia can be just as detrimental as no treatment. Different types of anemia may coexist in a patient in the intensive care unit, making diagnosis and differentiation among these anemias complex, therefore requiring good diagnostic skills. Although several therapeutic options are available to treat anemia, critically ill patients often receive a transfusion, and yet, most recent studies indicate that blood transfusions in critically ill patients are associated with worse outcomes, including higher morbidity and mortality. These studies have generated interest in the administration of exogenous erythropoietin and iron therapy. Unfortunately, the accurate determination of iron status can be a rather difficult task, an undertaking that is made even more difficult by the presence of comorbid conditions that can affect the commonly used parameters for guiding iron therapy. The use of erythropoiesis-stimulating agents is rapidly gaining acceptance, although they also present potential problems of their own.
Asare
Kwame
K
Department of Clinical Pharmacy, St. Thomas Hospital, Nashville, Tennessee 37202, USA.
D000740:Anemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D001802:Blood Substitutes / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic
D001802:Blood Substitutes; D006397:Hematinics; D007501:Iron