Blunted erythropoietic response to anemia in multiply traumatized patients

Hobisch-Hagen, Petra; Wiedermann, Franz J.; Mayr, Andreas; Fries, Dietmar; Jelkmann, Wolfgang; Fuchs, Dietmar; Hasibeder, Walter; Mutz, N.; Klingler, Antón; Schobersberger, Wolfgang

doi:10.1097/00003246-200104000-00009

Cited by 96 publications

(52 citation statements)

References 23 publications

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“…A survival time-dependent elevation in serum EPO level was detected for blunt injuries and fire fatality, suggesting the systemic influence of anemia/hypoxia following massive bleeding and/or tissue damage [33][34][35]. Similar findings for gastrointestinal bleeding and infectious diseases may be related to the severity and duration of bleeding/anemia or advanced hypoxia in the death process [35][36][37][38].…”

Section: Discussionmentioning

confidence: 62%

Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy

et al. 2008

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Circulating erythropoietin (EPO) is mainly produced in the kidneys, depending on blood oxygen level. The present study investigated the postmortem serum EPO levels with regard to the cause of death and survival time. Serial medicolegal autopsy cases of postmortem time within 48 h (n = 536) were examined. Serum EPO levels were within the clinical reference range in most cases. Uremic patients with medical administration of an EPO agent (n = 11) showed a markedly high level (140-4,850 mU/ml; median, 1,798 mU/ml). Otherwise, an elevation in serum EPO level (>30 mU/ml) was mainly seen in protracted deaths due to blunt injury and fire fatality, depending on the survival time (r = 0.69, p < 0.0001, and r = 0.45, p < 0.0001, respectively), and in subacute deaths from gastrointestinal bleeding and infectious diseases. However, mildly to moderately elevated serum EPO levels were sporadically found in acute deaths due to mechanical asphyxiation, fire fatality, and acute ischemic heart disease, and in fatal hypothermia cases, especially for elderly subjects. Protracted deaths due to mechanical asphyxiation and ischemic heart disease did not show any survival time-dependent increase in serum EPO level (p > 0.05). EPO was immunohistochemically detected in the tubular epithelia and interstitial cells, showing no evident difference among the causes of death, independent of survival time or serum level. These findings suggest that serum EPO can be used as a marker for investigating anemia and/or hypoxia as a consequence of fatal insult in subacute or prolonged deaths, or a predisposition to traumatic deaths or fatal heart attacks in acute deaths.

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Section: Discussionmentioning

confidence: 62%

Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy

et al. 2008

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“…1,[3][4][5][6][7] Recently, Krafte-Jacobs and colleagues demonstrated this phenomenon in critically ill children. 5 They showed that patients who were acutely anemic had serum erythropoietin concentrations that were significantly lower than erythropoietin concentrations measured in chronically anemic patients.…”

Section: Discussionmentioning

confidence: 95%

“…3 Adult patients who received rHuEPO 300 units/kg/day for 5 days, then every other day, were transfused with significantly fewer units of RBCs when compared with patients who did not receive rHuEPO. Currently, data demonstrating that rHuEPO reduces the number of RBC transfusions pediatric intensive care unit (PICU) patients receive is unavailable.…”

Section: Introductionmentioning

confidence: 99%

Prospective Randomized Double-Blind Placebo Controlled Trial of Recombinant Human Erythropoietin Administration to Reduce Blood Transfusions in Anemic Pediatric Intensive Care Patients

Chicella

Krueger

2006

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVEThe purpose of this study was to determine if the number of red blood cell (RBC) transfusions anemic pediatric intensive care unit patients receive could be reduced by the prophylactic administration of recombinant human erythropoietin (rHuEPO). METHODS This was a randomized, double-blind placebo controlled trial. Patients were randomized to receive either intravenous rHuEPO 300 units/kg/day or placebo. Both groups received elemental iron 6 mg/kg/day. RESULTS Twenty-seven patients, ages 1 month to 13 years, were enrolled. Baseline hematocrit (Hct), reticulocyte count, and erythropoietin concentration were similar between the two groups. Three patients randomized to rHuEPO received 1 RBC transfusion each, and 4 patients randomized to placebo received 9 transfusions total (P = .68). The end-of-study Hct was not significantly different between the rHuEPO and placebo groups, 30.3 ± 3.6 and 26.8 ± 4.8, respectively (P = .06). Additionally, neither the % Hct change (baseline to final), nor the % reticulocyte change (baseline to final), was statistically different between the two groups. CONCLUSION In this small group of anemic pediatric intensive care unit patients, prophylactic rHuEPO administration did not reduce the number of patients who received RBC transfusions. Furthermore, it did not significantly increase Hct or reticulocyte count when compared to placebo.

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“…7,12,13 However, their bone marrow may respond to exogenous erythropoietin (EPO) and this possibility has been explored in two clinical trials, including almost 1,500 intensive care unit (ICU) patients, conducted by Corwin et al 14,15 Compared to placebo, those patients treated with EPO received less ABT and achieved a higher hematocrit. However, there were no significant differences regarding morbid-mortality.…”

Section: Postoperative Anemia and Erythropoietinmentioning

confidence: 99%

Posters

2004

Transfus Alt Transfus Med

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Blunted erythropoietic response to anemia in multiply traumatized patients

Abstract: Multiply traumatized patients exhibit an inadequate EPO response to low hemoglobin concentrations. Thus, anemia in severe trauma is the result of a complex network of bleeding, blunted EPO response to low hemoglobin concentrations, inflammatory mediators, and a hypoferremic state.

Cited by 96 publications

References 23 publications

Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy

Postmortem serum erythropoietin levels in establishing the cause of death and survival time at medicolegal autopsy

Prospective Randomized Double-Blind Placebo Controlled Trial of Recombinant Human Erythropoietin Administration to Reduce Blood Transfusions in Anemic Pediatric Intensive Care Patients

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