anemia in critical illness

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  • 1. Critical Illness: Hematologic Complications Susan E. Segreti, MS, MEd, NP-C Syracuse Veterans Administration

2. Background

  • 55,000 ICU patients per day in USA
  • Incidence of hemorrhage, respiratory failure, multiple organ system failure, sepsis, and hemodynamic abnormalities

Thrombocytopenia Anemia Neutropenia 3.

  • 29% ICU patients anemic with admission
  • 95% ICU patients develop anemia volume/frequency

Anemia 4. Destruction RBC life span = 120 days Intrinsic defect sickle cell, thalassemia, or enzyme deficienciesExtrinsic process hemolysis:1) transfusions antibody attacks RBC membrane2) stasis enlarged spleen3) malfunctioning valves4) rapid infusions of hypotonic solutions5) mechanical trauma (invasive devices)6) medications PCN, sulfa, APAP, procainamide,methyldopa 5. Production Erythropoiesis 6. Production

  • Erythropoiesis development of mature RBCs:
  • O2 (Hgb) levels signals kidney toerythropoietin
  • With critical illness there is a blunted response
  • Proinflammatory cytokines also blunt response

7. 8. Management

  • Identify thecause
  • Transfuse 10/30 rule (tradition)Hgb < 10 g/dL or Hct < 30%Absence of acute bleeding Hgb