Document Detail


Anaemia and red blood cell transfusion in the critically ill patient.
MedLine Citation:
PMID:  14556774     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Anaemia is a common finding in critically ill patients. There are often multiple causes. Obvious causes include surgical bleeding and gastrointestinal haemorrhage but many patients have no overt bleeding episodes. Phlebotomy can be a significant source of blood loss. In addition, critically ill patients have impaired erythropoiesis as a consequence of blunted erythropoietin production and direct inhibitory effects of inflammatory cytokines. The ability of a patient to tolerate anaemia depends on their clinical condition and the presence of any significant co-morbidity; maintenance of circulating volume is of paramount importance. There is no universal transfusion trigger. Current guidelines for critically ill and perioperative patients advise that at Hb values <70 g/L red blood cell transfusion is strongly indicated and at Hb values >100 g/L transfusion is unjustified. For patients with Hb values in the range 70 to 100 g/L the transfusion trigger should be based on clinical indicators. Most stable critically ill patients can probably be managed with a Hb concentration between 70 and 90 g/L. Uncertainties exist concerning the most appropriate Hb concentration for patients with significant cardio-respiratory disease.
Authors:
S A McLellan; D B L McClelland; T S Walsh
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Blood reviews     Volume:  17     ISSN:  0268-960X     ISO Abbreviation:  Blood Rev.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-10-14     Completed Date:  2004-07-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8708558     Medline TA:  Blood Rev     Country:  Scotland    
Other Details:
Languages:  eng     Pagination:  195-208     Citation Subset:  IM    
Affiliation:
University Department of Anaesthetics, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW, UK. stu.mclellan@ed.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Anemia / etiology*,  physiopathology,  therapy*
Critical Illness
Erythrocyte Transfusion / adverse effects,  standards*
Erythropoiesis / drug effects,  physiology
Erythropoietin, Recombinant / therapeutic use
Humans
Chemical
Reg. No./Substance:
0/Erythropoietin, Recombinant

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