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Review
. 2022 Aug 5;1(2):e002.
doi: 10.1097/EA9.0000000000000002. eCollection 2022 Apr.

Patient blood management in the ICU: A narrative review of the literature

Vanessa Neef  1 , Lea Blum  1 , Lotta Hof  1 , Suma Choorapoikayil  1 , Kira Kieserling  1 , Patrick Meybohm  1 , Andrea U Steinbicker  1 , Kai Zacharowski  1 , Florian Piekarski  1
Affiliations
Review

Patient blood management in the ICU: A narrative review of the literature

Vanessa Neef et al. Eur J Anaesthesiol Intensive Care. .

Abstract

The majority of ICU patients are anaemic. Anaemia is associated with worse outcomes and a necessity for red blood cell transfusions. ICU patients are a heterogeneous patient group with a broad spectrum of main diagnoses and comorbidities. Evidence-based transfusion trigger guidelines have been established that are dependent on comorbidities. Special attention has been given to blood saving measures and point-of-care diagnosis of coagulation disorders in ICU patients. The administration of intravenous iron and erythropoiesis-stimulating agents can provide useful and individualised alternatives to the administration of red blood cell concentrates in treatment of iron deficiency anaemia. In presence of inflammation and infection, it is challenging to identify the cause of anaemia. The hepcidin-ferroportin pathway may facilitate the diagnosis of anaemia in ICU patients and indicate novel targets in anaemia treatment. This review article presents patient blood management measures and summarises the current literature on transfusion thresholds and alternative therapeutic options using intravenous iron and erythropoiesis-stimulating agents with a key focus on the ICU.

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Conflict of interest statement

Conflicts of interest: VN, LB, LH, SC and KK have no conflicts of interest. PM received honoraria for scientific lectures from CSL Behring GmbH and ViforPharma GmbH, and is supported by the German Research Foundation (Deutsche Forschungsgemeinschaft) grant ME3559/3-1 to perform a multicentre, prospective trial on RBC transfusion triggers. AUS is supported by the German Research Foundation (Deutsche Forschungsgemeinschaft) grant STE 1895/9-1, STE 1895/10-1 and a research grant from Pharmacosmos, Denmark, to perform a single-centre, prospective trial on pre-operative anaemia treatment. KZ and his department received support from B. Braun Melsungen, CSL Behring, Fresenius Kabi and Vifor Pharma for the implementation of Frankfurt‘s Patient Blood Management programme and received honoraria for scientific lectures from CSL Behring, implatcast GmbH, med Update GmbH, Pharmacosmos, GE Healthcare and Vifor Pharma and received honoraria for participation in advisory board meetings for Haemonetics and Vifor. He is the Principal Investigator of the EU-Horizon 2020 project ENVISION (Intelligent plug-and-play digital tool for real-time surveillance of COVID-19 patients and smart decision-making in Intensive Care Units) and Horizon Europe 2021 project COVend (Biomarker and AI-supported FX06 therapy to prevent progression from mild and moderate to severe stages of COVID-19). FP received honoraria from Pharmacosmos for scientific lectures.

Figures

FIGURE 1
FIGURE 1
Patient blood management measures in intensive care patients.
See this image and copyright information in PMC

References

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