Erythropoietin response is blunted in critically ill patients

Rogiers, Peter; Zhang, Haibo; Leeman, Marc; Nagler, Jan; Neels, Hugo; Mélot, Christian; Vincent, Jean‐Louis

doi:10.1007/s001340050310

Cited by 242 publications

(140 citation statements)

References 17 publications

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“…However, during critical illness, circulating EPO concentrations fall quickly and remain inappropriately low because of a combination of decreased renal function and proinflammatory cytokine inhibition of EPO production (25,26). In addition to suppressed RBC production, a sudden and continued drop in EPO production with the onset of any acute inflammatory condition may promote neocytolysis and eryptosis as discussed earlier.…”

Section: Etiology Of Anemia In Critical Illnessmentioning

confidence: 99%

Anemia in Critical Illness

Hayden

Albert

Watkins

et al. 2012

Am J Respir Crit Care Med

194

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Anemia is common in the intensive care unit, and may be associated with adverse consequences. However, current options for correcting anemia are not without problems and presently lack convincing efficacy for improving survival in critically ill patients. In this article we review normal red blood cell physiology; etiologies of anemia in the intensive care unit; its association with adverse outcomes; and the risks, benefits, and efficacy of various management strategies, including blood transfusion, erythropoietin, blood substitutes, iron therapy, and minimization of diagnostic phlebotomy.

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Section: Etiology Of Anemia In Critical Illnessmentioning

confidence: 99%

Anemia in Critical Illness

Hayden

Albert

Watkins

et al. 2012

Am J Respir Crit Care Med

194

View full text Add to dashboard Cite

show abstract

“…The feedback loop of oxygen tension, erythropoietin levels, and erythropoiesis described previously is disrupted in patients with inflammatory anemia. 15 Similar to patients with chronic inflammatory disease, those with inflammatory anemia have blunted erythropoietin production and down-regulation of erythropoietin receptors in the bone marrow, although many patients retain their responsiveness to erythropoietin. 16 Additionally, release of inflammatory cytokines leads to reduced renal erythropoietin production (thus decreased RBC production) and activation of RBC destruction by macrophages (eryptosis), which not only decreases the absolute number of RBCs but also reduces RBC life span, and decreased responsiveness of the bone marrow to erythropoietin (and thus decreased RBC production).…”

Section: Anemia Of Chronic Diseasementioning

confidence: 99%

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

McEvoy

Shander

2013

American Journal of Critical Care

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The definition of anemia is controversial and varies with the sex, age, and ethnicity of the patient. Anemia afflicts half of hospitalized patients and most elderly hospitalized patients. Acute anemia in the operating room or intensive care unit is associated with increased morbidity as well as other adverse outcomes, including death. The risks of anemia are compounded by the added risks associated with transfusion of red blood cells, the most common treatment for severe anemia. The causes of anemia in hospitalized patients include iron deficiency, suppression of erythropoietin and iron transport, trauma, phlebotomy, coagulopathies, adverse effects of and reactions to medications, and stress-induced gastrointestinal bleeding. The types and causes of anemia and the increased health care utilization and costs associated with anemia and undetected internal bleeding are described. The potential benefits and risks associated with transfusion of red blood cells also are explored. Last, the strategies and new tools to help prevent anemia, allow earlier detection of internal bleeding, and avoid unnecessary blood transfusions are discussed.

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“…Erythropoetin levels below those expected for the degree of anemia have been demonstrated in septic and critically ill patients [69,70]. There is evidence that inflammatory cytokines have play an inhibitory role on erythropoietin production as well as a direct inhibitory effect on erythroid progenitor cell production in the bone marrow [71][72][73][74][75].…”

Section: Erythropoesismentioning

confidence: 99%

Red Blood Cell Transfusion in Sepsis: A Review

Sadaka¹

2013

J Blood Disord Transfus

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Sepsis is very common and lethal. Sepsis is the leading cause of death in non-coronary Intensive Care Units, and the tenth leading cause of death overall. Red blood cell transfusion is one of the most commonly used interventions in the ICU to treat severe anemia, which often occurs in sepsis. Several problems were documented with RBC transfusions and will be reviewed, such as infection, pulmonary complications such as TRALI and Transfusion-Associated Circulatory Overload (TACO), Transfusion-Related Immunomodulation (TRIM) and multiorgan failure, and increased mortality. Most of these complications are partially explained by volume of the unit of blood as well as pathogenic factors of stored RBCs related to 2,3 BPG concentration, inflammatory mediators, nitric oxide, ATP concentration and RBC rheology, and RBC adhesion characteristics. These same factors are present in RBCs of septic patients as well. Until better evidence is available, a "restrictive" strategy of RBC transfusion (transfuse when Hb < 7 g/dL) is recommended except in acute hemorrhage, or in patients with acute myocardial ischemia when a hemoglobin trigger of 8 g/dl is reasonable.

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Erythropoietin response is blunted in critically ill patients

Abstract: EPO levels can be inappropriately low in critically ill patients, so that EPO deficiency may contribute to the development of anaemia in these patients. This phenomenon is observed not only in the presence of acute renal failure, but also in the presence of sepsis.

Cited by 242 publications

References 17 publications

Anemia in Critical Illness

Anemia in Critical Illness

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

Red Blood Cell Transfusion in Sepsis: A Review

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