Erythropoietin-receptor agonists in critically ill patients: a meta-analysis of randomized controlled trials

Hepcidin and Anemia of the Critically Ill Patient

“…However, a recent meta-analysis of nine randomized control trials demonstrated only a small reduction in the number of patients undergoing transfusion (odds ratio, 0.73; 95% confidence interval, 0.64 -0.84; I 2 ϭ 54.7%) and a small reduction in the number of units transfused per patient (odds ratio, Ϫ0.41; 95% confidence interval, 0.10 -0.74; I 2 ϭ 79.2%). 5 To date there is no recommendation for the use of ESA in critically ill patients. However, it has to be underscored that only one study administered intravenous iron in association with ESA.…”

“…Because blood transfusion is not an option for complete correction of this anemia, 1 one may advocate the use of other treatments, such as erythropoiesis-stimulating agents (ESA) or iron. ESA efficacy has been studied in critically ill patients and has not proven to be indicated, 5 at least according to the design of the studies. Iron is needed for erythropoiesis and thus may be indicated for the treatment of this anemia, but iron is also a toxic compound with the ability to induce oxidative stress or promote bacterial growth.…”

Anemia, Bleeding, and Blood Transfusion in the Intensive Care Unit: Causes, Risks, Costs, and New Strategies

“…This area remains controversial. A metaanalysis 19 evaluating the effect of erythropoietinreceptor agonists on transfusion frequency showed a small reduction in RBC transfusions, and with other studies suggesting that erythropoietin therapy is associated with increased rates of clinically rele- 25 an opportunity exists for blood conservation strategies to make a significant difference without affecting the collection of physiological data to guide treatment. Strategies to reduce diagnostic blood sampling include switching to small-volume or pediatric phlebotomy tubes, replacing routine multiple daily phlebotomies for blood sampling only when clinical signs indicate the need, and implementing closed-loop systems that return blood that is ordinarily wasted back to the patient.…”

Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients

“…They found a significant reduction in the odds of a patient receiving at least 1 red blood cell transfusion (odds ratio 0.73, 95% CI 0.64-0.84). 65 There were no differences observed in mortality or occurrence of deep vein thrombosis. On the basis of these findings, erythropoietin appears effective in increasing hemoglobin levels in critically ill patients and may result in a reduced frequency of blood transfusions, but this latter effect is likely abrogated by the use of a restrictive transfusion strategy.…”

“…Recombinant erythropoietin has also been used in critically ill patients for the same purpose. 65 In the most recently published trial, Corwin and colleagues 66 randomly assigned 1460 critically ill patients to receive either 40 000 units of recombinant erythropoietin or placebo weekly for up to 3 weeks. The increase in hemoglobin concentration at day 29 was greater in the erythropoietin group than in the placebo group (mean 16 [SD 20] g/L v. 13 [SD 18] g/L, p < 0.001).…”