[Is there still a role for recombinant erythropoietin in the management of anaemia of critical illness?].
There is a high prevalence of anaemia among patients admitted to the intensive care unit (ICU), and it may have a negative effect on patient's outcome. The most common treatment for anaemia in the ICU patient is allogeneic blood transfusion (ABT), yet it has been found to be a risk factor associated with an increased risk of morbidity and mortality in critical care patients. As a reduction of erythropoietin secretion and action is observed in most ICU patients, the administration of (rHuEPO) has emerged as a therapeutic option. Unfortunately, the results from different studies show that rHuEPO treatment results in a small reduction of ABT requirements when "restrictive" transfusion criteria are applied, which has only been supported by three of the studies. Yet this did not result in a decreased mortality rate, except for patients with a diagnosis on admission of trauma in two studies, even though one study reported a dose-dependent increase of thrombotic vascular events among patients without thromboprophylaxis. Altogether, clinical data suggest a role for rHuEPO in the treatment of anaemia in trauma patients, especially in those sustaining neurotrauma, whereas for non-trauma patients without an approved indication, rHuEPO administration is an expensive approach, does not seem to improve outcome, and might result in serious adverse effects. Consequently, more basic and clinical studies are required to ascertain which patients are more likely to benefit from these treatments, as well as to identify the optimal doses and administration schedules, and iron administration.
Muñoz
Manuel
M
Medicina Transfusional, Facultad de Medicina, Universidad de Málaga, Málaga, España.
Ramón Leal-Noval
Santiago
S
García-Erce
José Antonio
JA
D000740:Anemia / Q000188:drug therapy* / Q000401:mortality; D016638:Critical Illness; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin