HEMATOLOGICAL DERANGEMENTS IN CRITICALLY ILL PATIENTS

Abstract

Anemia of chronic disease, or anemia of chronic inflammation, is a form of anemia seen in chronic infection,chronic immune activation,and malignancy.These conditions all produce massive elevation of Interleukin-6,which stimulates hepcidin production and release from the liver,which in turn reduces the iron carrier protein ferroportin so that access of iron to the circulation is reduced.hepcidin is the central actor in producing anemia of chronic inflammation.there are other mechanisms that also contribute to the lowering of hemoglobin levels during inflammation:(i) Inflammatory cytokines suppress the proliferation of erythroid precursors in the bone marrow,(ii) inflammatory cytokines inhibit the release of erythropoietin (EPO) from the kidney and (iii) the survival of circulating red cells is shortened.The ideal treatment for anemia of chronic disease is to treat the chronic disease successfully.Parenteral iron is increasingly used for anemia in chronic renal disease and inflammatory bowel disease.Erythropoietin can be helpful, but this is costly and may be dangerous.Erythropoietin is advised either in conjunction with adequate iron replacement which in practice is intravenous, or when IV iron has proved ineffective.Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood lost during surgery. Blood transfusions may also be used to treat a severe anaemia or thrombocytopenia caused by a blood disease.Thrombocytopenia is the medical term for a low blood platelet count.Platelets (thrombocytes) are colorless blood cells that play an important role in blood clotting. Platelets stop blood loss by clumping and forming plugs in blood vessel holes.Thrombocytopenia often occurs as a result of a separate disorder, such as leukemia or an immune system problem, or as a medication side effect.Thrombocytopenia may be mild and cause few signs or symptoms.In rare cases, the number of platelets may be so low that dangerous internal bleeding can occur.Coagulation abnormalities are commonly found in critically ill patients such as thrombocytopenia, prolonged global coagulation times, reduced levels of coagulation inhibitors, or high levels of fibrin split products.Prompt and proper identification of the underlying cause of these coagulation abnormalities is required, since each coagulation disorder necessitates very different therapeutic management strategies.For decades,Vitamin K antagonists were the only class of oral anticoagulants available to clinicians,with the US Food and Drug Administration approval of new oral anticoagulants, such as dabigatran, rivaroxaban, and apixaban, clinicians now have abroader choice.