BJA Advance Access originally published online on July 27, 2006
British Journal of Anaesthesia 2006 97(3):278-291; doi:10.1093/bja/ael189
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Anaemia during critical illness
1 Anaesthetics, Critical Care and Pain Medicine, New Edinburgh Royal Infirmary, Little France Crescent Edinburgh, Scotland EH16 2SA
2 Present address: Department of Anaesthetics, Menoufia University Egypt
*Corresponding author: Anaesthetics, Critical Care and Pain Medicine, New Edinburgh Royal Infirmary, Little France Crescent, Edinburgh, Scotland EH16 2SA. E-mail: Timothy.Walsh@ed.ac.uk
Keywords: blood, erythrocytes; blood, transfusion; complications, anaemia; intensive care
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Introduction |
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Anaemia occurs frequently during critical illness. Recent studies have increased our understanding of how well critically ill patients tolerate anaemia. It is known that anaemia does not result simply from diagnostic and physical blood loss, but is multifactorial in origin. Recently, abnormalities in circulating red cell function have been described that are potentially relevant to efficient oxygen delivery. Potential new approaches to the management of the anaemic patient during critical illness have also been evaluated.
This narrative review considers methodological issues relevant to understanding the critical care literature on anaemia. We summarize current understanding of the prevalence of anaemia during critical illness, specifically among patients in intensive care units (ICUs), and discuss the various factors that contribute to its development. We consider how red cell function may alter during critical illness and the possible clinical relevance of these changes. The treatment of anaemia is discussed, with particular emphasis on haemoglobin
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Definition of anaemia |
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Interpreting the critical care transfusion literature |
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Prevalence of anaemia during critical illness |
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Anaemia at ICU admission
Anaemia during ICU stay
Anaemia after ICU discharge
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Aetiology of anaemia during critical illness |
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Haemodilution
Blood loss
Blood sampling
Haemorrhage
Reduced red cell survival
Reduced red cell production
Iron metabolism
B12 and folate metabolism
Inappropriately low circulating erythropoietin concentrations
Abnormal red blood cell maturation
Summary of factors contributing to anaemia during critical illness
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Red cell function during critical illness |
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Red cell deformability
Oxygen unloading
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Management of anaemia |
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Reduction of red cell loss
Transfusion triggers
Critical haemoglobin concentration
Acceptable haemoglobin concentration during critical illness
Possible exceptions to the restrictive strategy used in the TRICC trial
The patient with chronic ischaemic heart disease
The patient with an acute coronary syndrome
Early severe sepsis
Risks from allogeneic blood transfusion
Erythropoietin therapy
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Conclusions and unanswered questions |
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