12. ICU Anaemia

Question 1

List possible causes for anaemia in critically ill patients

Pre Existing

Answer 1

Pre existing

1, IDA / Vit b12 / Folate

2. ACD (Renal failure)
3. Hbopathy - Thalassaemia
4. Chronic alcohol
5. Drugs: folate antagonists
6. Haematologic (MDS)

Question 2

Acquire

Answer 2

Loss of red cell

• Surgical bleeding
• Trauma
• GIB
• Destruction
• Hemofiltration / Haemolytic
• Regular sampling

Failures in hemopoiesis

• Multiact ~~ ACD
• Less prod EPO
• Less Red marrow sens to EPO
• Increased hepcidin reduces serum iron

Question 3

Risks of transfusion

Answer 3

1) Immune
2) Infective
3) Other
4) Mortality

Question 4

Immune

Answer 4

Acute

• Haemolysis - ABO incompatibility
• Anaphylaxis
• Pyrexia
• TRALI

Delayed

• Haemolysis 7d later
• Blood component reaction
  proteins / platelets (reducing w/ leucodepletion RCC)

Late

Rhesus exposure in Rh - women

Question 5

Infective

Answer 5

Hep B C (screened in UK)

HIV

CJD
-receip packed cell since 1980 excluded donated

• Other CMV / Malaria / Syphilis

Question 6

Other

Answer 6

Metabolic
- hyperK

• Citrate toxicity
  (hypoCa & met alkalosis from citrate metab = bicarb)
• Hypothermia
  Stored @4c

Impaired O2 deliver post transfusion

• 2,3 DPG less
• left shift O2 dissoc curve
• Microparticulate emboli can form in stored blood
• Coagulopathy if only RCC transfused

Question 7

Mortality

Answer 7

TRICC study
lower mortality
younger healthier ICU
- lower transfusion target vs more liberal

CRIT study
Packed red cell ICU stay
- independent mortality predictor

SOAP

• No a/w mortality and transfusion
• ? effects of leucodepletion