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Anaemia at discharge from the intensive care unit is associated with an inappropriate erythropoietin response

Background and objectives

The adoption of a restrictive transfusion practice in our unit has led to a high prevalence of significant anaemia during the ICU stay, which persists to level 3 (L3) discharge. There has been little research exploring the recovery of anaemia following critical illness. We investigated the aetiology of the anaemia in patients at discharge from intensive care.

Setting and patients

An 18-bed general intensive care unit within a tertiary hospital. Patients who required > 48 hours L3 care and were anaemic at time of L3 discharge were recruited. Exclusion occurred if renal replacement therapy or immunosuppression was required at time of discharge, or if patients had a chronic haematological abnormality.

Methods

Haemoglobin (Hb) and erythropoietin (EPO) levels were measured within 5 days of L3 discharge, along with the percentage of hypochromic red cells (%HYPO), reticulocyte haemoglobin content (CHr), reticulocyte count, ferritin and vitamin B12 and folate levels.

Baseline characteristics

Presented as median (first and third quartiles); range. Twenty male and 10 female patients were recruited with the following characteristics: age: 66.5 years (55.5, 77); 35–83. APACHE II score 21 (16, 24); 7–38. ICU length of stay (LOS): 12 days (9, 23.25); 2–46.

Results

Data are presented in Table 1.

Table 1

Conclusions

Anaemia persisting at ICU discharge is associated with an inappropriate EPO response in the majority of patients. The elevated reticulocyte count suggests that the erythropoietic response has been initiated despite low EPO levels but this is inadequate to correct anaemia. There is no evidence of vitamin B12 or folate deficiency. The normal CHr suggests little evidence of current functional iron deficiency but the elevated %HYPO in 40% of patients suggests that depleted iron stores may have limited erythropoiesis at some point during the ICU stay. Further work is required to determine factors contributing to the inappropriate EPO response.

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Bateman, A., Mills, G. & Walsh, T. Anaemia at discharge from the intensive care unit is associated with an inappropriate erythropoietin response. Crit Care 9, P335 (2005). https://doi.org/10.1186/cc3398

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Keywords

  • Erythropoietin
  • Reticulocyte Count
  • General Intensive Care Unit
  • Restrictive Transfusion
  • Functional Iron Deficiency