Anemia in Intensive Care: A review of Current Concepts

Rawal, Gautam; Kumar, Rajiv; Yadav, Sankalp; Singh, Amrita

doi:10.1515/jccm-2016-0017

Cited by 27 publications

(21 citation statements)

References 40 publications

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“…As many as 97% of patients are anemic after a week in ICU care [ 29 , 30 ]. Decreased erythropoiesis, frequent blood sampling and bleeding are known reasons why anemia is common among ICU patients [ 31 ]. Interestingly, no signs were found of more severe anemia in patients with higher doses of anticoagulation, perhaps because COVID-19 patients are hypercoagulable and might not bleed easily despite high-dose thromboprophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Dosing of thromboprophylaxis and mortality in critically ill COVID-19 patients

et al. 2020

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Background A substantial proportion of critically ill COVID-19 patients develop thromboembolic complications, but it is unclear whether higher doses of thromboprophylaxis are associated with lower mortality rates. The purpose of the study was to evaluate the association between initial dosing strategy of thromboprophylaxis in critically ill COVID-19 patients and the risk of death, thromboembolism, and bleeding. Method In this retrospective study, all critically ill COVID-19 patients admitted to two intensive care units in March and April 2020 were eligible. Patients were categorized into three groups according to initial daily dose of thromboprophylaxis: low (2500–4500 IU tinzaparin or 2500–5000 IU dalteparin), medium (> 4500 IU but < 175 IU/kilogram, kg, of body weight tinzaparin or > 5000 IU but < 200 IU/kg of body weight dalteparin), and high dose (≥ 175 IU/kg of body weight tinzaparin or ≥ 200 IU/kg of body weight dalteparin). Thromboprophylaxis dosage was based on local standardized recommendations, not on degree of critical illness or risk of thrombosis. Cox proportional hazards regression was used to estimate hazard ratios with corresponding 95% confidence intervals of death within 28 days from ICU admission. Multivariable models were adjusted for sex, age, body mass index, Simplified Acute Physiology Score III, invasive respiratory support, and initial dosing strategy of thromboprophylaxis. Results A total of 152 patients were included: 67 received low-, 48 medium-, and 37 high-dose thromboprophylaxis. Baseline characteristics did not differ between groups. For patients who received high-dose prophylaxis, mortality was lower (13.5%) compared to those who received medium dose (25.0%) or low dose (38.8%), p = 0.02. The hazard ratio of death was 0.33 (95% confidence intervals 0.13–0.87) among those who received high dose, and 0.88 (95% confidence intervals 0.43–1.83) among those who received medium dose, as compared to those who received low-dose thromboprophylaxis. There were fewer thromboembolic events in the high (2.7%) vs medium (18.8%) and low-dose thromboprophylaxis (17.9%) groups, p = 0.04. Conclusions Among critically ill COVID-19 patients with respiratory failure, high-dose thromboprophylaxis was associated with a lower risk of death and a lower cumulative incidence of thromboembolic events compared with lower doses. Trial registration Clinicaltrials.gov NCT04412304 June 2, 2020, retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

Dosing of thromboprophylaxis and mortality in critically ill COVID-19 patients

et al. 2020

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“…In relation to the heart, both HTN and DM can predispose to myocardiopathy (59) and in presence of viral respiratory infections, like flu annually (60) or now in COVID-19 (61), can predispose to heart failure (HF). This is without doubt the most frequent cardiac complication of these patients, especially if we add anaemia and/or tachyarrhythmia (flutter and atrial fibrillation, episodes of supraventricular or ventricular tachycardia) both not uncommon in Intensive Care Units (62,63).…”

Section: Insufficient Response To the Tested Treatment A Change Of Smentioning

confidence: 97%

COVID-19: A Personalized Cardiometabolic Approach for Reducing Complications and Costs. The Role of Aging beyond Topics

Sabán-Ruiz¹,

Ly-Pen²

2020

The Journal of nutrition, health and aging

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“…Decreasing or persistently low concentrations of blood lactate during critical illness signify a favourable prognosis ( 3 ). However, frequent blood sampling and copious amounts of blood drawn represent a serious problem due to the phlebotomy related blood loss in ICU patients ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of different pre-analytical conditions on plasma lactate concentration

Rako

Mlinarić

Dozelencic³

et al. 2018

Biochemia Medica

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IntroductionPlasma lactate is a frequently used and important parameter for medical decision making. To setup a pre-analytical algorithm, we aimed to investigate the influence of different test tube additives, aliquoting, ice storage and haemolysis on plasma lactate concentrations for possible sparing critically ill (ICU) patients of additional blood drawing.Materials and methodsIn our study (N = 177), lactate concentration and haemolysis index (HI) were measured in aliquoted (AHP) and unaliquoted (HP) Li-heparin, NaF/K3EDTA and NaF/KOX plasma, centrifuged within 15 minutes after venipuncture, on Cobas c501 analyzer. Differences were tested using the Wilcoxon’s test and Passing-Bablok regression. Clinical accuracy of results was assessed in 107 ICU patients based on reference interval and clinical decision limits.ResultsLactate concentrations did not differ in NaF/K3EDTA and NaF/KOX plasma (P = 0.855). No clinically significant difference of AHP compared to NaF/K3EDTA lactate was found (y = 0.13 (0.08 to 0.19) + 1.02 (0.99 to 1.08) x) if samples were aliquoted within 30 minutes after venipuncture. On contrary, lactate concentrations in HP showed significant proportional difference (y = 0.07 (- 0.12 to 1.24) + 1.37 (1.22 to 1.56) x) and were clinically incorrect in 14% of patients. Transport in ice bath increases HI in NaF/K3EDTA (P < 0.001), but without influencing lactate results compared to room temperature (y = 0.03 (- 0.06 to 1.00) + 1.05 (0.99 to 1.11) x).ConclusionsLactate determination in HP is unacceptable because of high proportional error and high risk of clinical inaccuracy compared to NaF/K3EDTA. If pre-analytical conditions are met, AHP, NaF/K3EDTA and NaF/KOX plasma can be used interchangeably. Aliquoted Li-heparin samples alow measurement of other biochemical tests from a single tube and can spare ICU patients from additional blood drawing. Storage in ice bath provides no additional stabilization in NaF/K3EDTA tubes.

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Anemia in Intensive Care: A review of Current Concepts

Cited by 27 publications

References 40 publications

Dosing of thromboprophylaxis and mortality in critically ill COVID-19 patients

Dosing of thromboprophylaxis and mortality in critically ill COVID-19 patients

COVID-19: A Personalized Cardiometabolic Approach for Reducing Complications and Costs. The Role of Aging beyond Topics

Effect of different pre-analytical conditions on plasma lactate concentration

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