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

Abstract

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).

Impact of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial

“…It is now recommended (low grade recommendation) by the French societies of critical care to treat anemia with erythropoietin in ICU [37]. Importantly, we did not observe any side-effects of ID treatment (neither related to IV iron nor to EPO), so that the benefit-risk balance seems largely positive [38].…”

Interest of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

“…In addition, EPO treatment has also been shown to reduce mortality in critically ill patients and may have contributed to the lower mortality rate we observed [35,36]. It is now recommended (low grade recommendation) by the French societies of critical care to treat anemia with erythropoietin in ICU [37]. Importantly, we did not observe any side-effects of ID treatment (neither related to IV iron nor to EPO), so that the bene t-risk balance seems largely positive [38].…”

Iatrogenic blood loss due to daily laboratory testing and the risk of subsequent anaemia in intensive care unit patients: case series

“…Anaemia was defined according to the WHO criteria (Blanc et al, 1968). The range of MCV <80 fL, 80-100 fL and >100 fL was used to describe anaemia as microcytic, normocytic and macrocytic, respectively (Lasocki et al, 2020).…”

“…Anaemia is a common clinical problem in critically ill patients with an upon-admission prevalence reaching about two-thirds of the intensive care unit (ICU) patients (Lasocki et al, 2020). The World Health Organisation (WHO) defines anaemia based on the sex and haemoglobin concentration (HGB) (Blanc et al, 1968) with the value of HGB below 120 gL -1 in women and 130 gL -1 in men being the cut-off values.…”

“…Diagnostic blood loss (DBL) may also contribute to anaemia occurrence. Management and prevention of anaemia in the ICU are difficult, complex and multidirectional (Lasocki et al, 2020). In this study, we aimed to evaluate DBL and its impact on HGB concentration and developing anaemia in patients during the first week of the hospitalization in ICU.…”