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Georgopoulos, Dimitris; Matamis, D.; Routsi, Christina; Michalopoulos, Argiris; Maggina, Nina; Dimοpoulos, George; Zakynthinos, Epaminondas; Nakos, George; Thomopoulos, George N.; Mandragos, K.; Maniatis, Alice

doi:10.1186/cc3786

Cited by 46 publications

(4 citation statements)

References 29 publications

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“…In the majority of randomised controlled trials evaluating ESA in critical care patients, administration of ESA was stopped when Hb exceeded the threshold of 12.0 g/dL [ 63 , 64 , 67 ]. A meta-analysis of nine trials including 5143 non-critical care chronic kidney disease patients treated by ESA showed a higher mortality when a high Hb target (≥ 12.0 g/dL) was used compared to lower Hb targets (10.0–12.0 g/dL) [RR: 1.17 (1.01–1.35] [ 73 ].…”

Section: Field 3: In Critical Care Patients Which Non-transfusional mentioning

confidence: 99%

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Lasocki

Pène

Ait‐Oufella

et al. 2020

Ann. Intensive Care

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Objective: Anemia is very common in critical care patients, on admission (affecting about two-thirds of patients), but also during and after their stay, due to repeated blood loss, the effects of inflammation on erythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated with severity of illness and length of stay. Methods: A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT, evaluated three fields: (1) anemia prevention, (2) transfusion strategies and (3) non-transfusion treatment of anemia. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE ® methodology. Results: The SFAR-SRLF guideline panel provided ten statements concerning the management of anemia in adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for ten recommendations. Three of these recommendations had a high level of evidence (GRADE 1±) and four had a low level of evidence (GRADE 2±). No GRADE recommendation could be provided for two questions in the absence of strong consensus. Conclusions: The experts reached a substantial consensus for several strong recommendations for optimal patient management. The experts recommended phlebotomy reduction strategies, restrictive red blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless of storage time, treatment of anaemic patients with erythropoietin, especially after trauma, in the absence of contraindications and avoidance of iron therapy (except in the context of erythropoietin therapy).

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Section: Field 3: In Critical Care Patients Which Non-transfusional mentioning

confidence: 99%

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Lasocki

Pène

Ait‐Oufella

et al. 2020

Ann. Intensive Care

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“…In contrast, anaemic critically ill patients treated with intravenous iron sucrose (20 mg/day) experienced an improvement of systemic inflammatory response (reduction of C‐reactive protein levels) and a trend towards reduced transfusion and mortality rates, when compared to those in a control group who only received folic acid [67]. In a recent study, the cumulative number of red blood cell units transfused and the percentage of transfused patients were significantly lower in intensive care unit patients receiving intravenous iron sucrose (100 mg three times a week) and subcutaneous rHuEPO (40 000 units once per week or three times per week) than in patients receiving iron sucrose alone, although there were no significant differences in morbid/mortality rates among the three groups [68] (Table 4). However, this protocol resulted in both a lower transfusion rate and a net increase in Hb levels, when compared to data reported by Corwin et al .…”

Section: Critically Ill Patientsmentioning

confidence: 99%

Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion

et al. 2007

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Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion Muñoz, M; Breymann, C; García-Erce, J A; Gómez-Ramírez, S; Comin, J; Bisbe, E Muñoz, M; Breymann, C; García-Erce, J A; Gómez-Ramírez, S; Comin, J; Bisbe, E (2008 Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion Abstract Anaemia is a common condition among patients admitted to hospital medicosurgical departments, as well as in critically ill patients. Anaemia is more frequently due to absolute iron deficiency (e.g. chronic blood loss) or functional iron deficiency (e.g. chronic inflammatory states), with other causes being less frequent. In addition, preoperative anaemia is one of the major predictive factors for perioperative blood transfusion. In surgical patients, postoperative anaemia is mainly caused by perioperative blood loss, and it might be aggravated by inflammation-induced inhibition of erythropoietin and functional iron deficiency (a condition that cannot be corrected by the administration of oral iron). All these mechanisms may be involved in the anaemia of the critically ill. Intravenous iron administration seems to be safe, as very few severe side-effects were observed, and may result in hastened recovery from anaemia and lower transfusion requirements. However, it is noteworthy that many of the recommendations given for intravenous iron treatment are not supported by a high level of evidence and this must be borne in mind when making decisions regarding its application to a particular patient. Nonetheless, this also indicates the need for further large, randomized controlled trials on the safety and efficacy of intravenous iron for the treatment of anaemia in different clinical settings. Department of Internal Medicine, University Hospital Virgen de la Victoria, Málaga. Spain. 5Department of Cardiology, Hospital Mar-Esperanza, Barcelona, Spain. 6Department of Anaesthesiology, Hospital Mar-Esperanza, Barcelona, Spain. Correspondence:Prof. Manuel Muñoz.AWGE. AbstractAnaemia is common in medical, surgical and critically ill patients, mostly due to absolute or functional iron deficiency (e.g.chronic blood loss or chronic inflammatory states respectively). Other causes are less frequent. Its presence is predictive for perioperative blood transfusion. Postoperative anaemia is mainly caused by blood loss, and may be aggravated by inflammation-induced inhibition of erythropoietin and functional iron deficiency (not correctable by the administration of oral iron). All these mechanisms may be involved in the anaemia of the critically ill. Intravenous iron administration seems to be safe, with few severe side-effects, and may hasten recovery from anaemia and reduce transfusion requirements. All the same, many indications given for IV iron are not supported by much evidence, which must be borne in mind when making decisions for a particular patient. Thus we need large, randomized controlled trials on the safety and efficacy of IV iron for the trea...

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“…It should be noted that only 1 study in the meta-analysis administered intravenous iron in association with EPO. In that study, the effect of EPO treatment was greater in terms of a reduced need for blood transfusion and increase in hemoglobin concentrations [18].…”

Section: Erythrocyte Phagocytosis -Band 3 and Cd47mentioning

confidence: 86%

Red Blood Cell Clearance in Inflammation

Straat

Bruggen²,

Korte³

et al. 2012

Transfus Med Hemother

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Anemia is a frequently encountered problem in the critically ill patient. The inability to compensate for anemia includes several mechanisms, collectively referred to as anemia of inflammation: reduced production of erythropoietin, impaired bone marrow response to erythropoietin, reduced iron availability, and increased red blood cell (RBC) clearance. This review focuses on mechanisms of RBC clearance during inflammation. We state that phosphatidylserine (PS) expression in inflammation is mainly enhanced due to an increase in ceramide, caused by an increase in sphingomyelinase activity due to either platelet activating factor, tumor necrosis factorα, or direct production by bacteria. Phagocytosis of RBCs during inflammation is mediated via RBC membrane protein band 3. Reduced deformability of RBCs seems an important feature in inflammation, also mediated by band 3 as well as by nitric oxide, reactive oxygen species, and sialic acid residues. Also, adherence of RBCs to the endothelium is increased during inflammation, most likely due to increased expression of endothelial adhesion molecules as well as PS on the RBC membrane, in combination with decreased capillary blood flow. Thereby, clearance of RBCs during inflammation shows similarities to clearance of senescent RBCs, but also has distinct entities, including increased adhesion to the endothelium.

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Abstract: Introduction The aim of this study was to assess the efficacy of two dosing schedules of recombinant human erythropoietin (rHuEPO) in increasing haematocrit (Hct) and haemoglobin (Hb) and reducing exposure to allogeneic red blood cell (RBC) transfusion in critically ill patients.

Cited by 46 publications

References 29 publications

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Efficacy and safety of intravenous iron therapy as an alternative/adjunct to allogeneic blood transfusion

Red Blood Cell Clearance in Inflammation

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