Canterbury DHB

Context

The critically ill and anaemic adult patient who declines blood products

There are clearly multiple factors which determine survival in the critically ill patient. A number of studies have demonstrated that transfusions do not translate to an improved mortality and may even be associated with a worse prognosis [14]. Patients with ischaemic heart disease, however, benefit from higher (10g/dL) haemoglobin concentrations [15].

Although previously thought to be ineffective in critically ill patients, recombinant human erythropoietin has also been used in this setting [16]. A randomised controlled trial showed that a weekly Epo dose of 40 000 iu led to increased Hb and reduced transfusion requirements in non-JW patients but further studies are required to assess whether clinical outcome is affected [17]. Doses of Epo used in this setting have also varied widely. In this setting, if the treating clinician feels erythropoietin is indicated, in the absence of evidence-based dosing regimens, the schedule described above in the paragraph entitled ‘enhance haemoglobin production’ can be considered.

Respiratory support in the form of a ventilator can help reduce myocardial oxygen consumption and early discussion with critical care is advocated.

About this Canterbury DHB document (47849):

Document Owner:

Julia Czuprynska and Richard Seigne (see Who's Who)

Issue Date:

August 2014

Next Review:

August 2016

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 47849