Blood Disorders in Critically Ill Patients
Abubakr Ahmed Abdou Mohammed;
Abstract
Major blood disorders are frequently encountered in the intensive care unit, which include anemia, thrombocytopenia and disseminated intravascular coagulopathy.
Anemia often develops early in the course of critical illness. The causes of anemia in ICU include blood loss, blunted erythropoietin response, inflammation and increased RBCs destruction.
The established method for managing anemia in the ICU is allogeneic red cell transfusion. The key question in deciding how to use red cell transfusion in the ICU, is identifying the most appropriate transfusion trigger and the target haemoglobin range for each patient.
Recombinant human erythropoietin (rHuEPO) may represent a therapeutic option for the treatment of anemia of critical illness and an additional way to conserve RBCs in the ICU.
Thrombocytopenia is very common in critically ill patients treated in the ICU. It is caused by is caused by many reasons such as immune-mediated thrombocytopenia, drugs or toxins, intra-aortic balloon pump/intravascular device use, hypersplenism and microangiopathic hemolytic anemia as DIC.
DIC is common in ICU patients, as it is a comorbidity of many of the diagnoses, which lead to ICU admission. While DIC is not a primary disorder, it is a marker of an underlying systemic process.Treatment of DIC is treatment of the underlying disorder aggressively, restoration of adequate circulatory volume and coagulation potential as quickly as possible.
Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood loss during surgery. Blood transfusions may be also used to treat severe anemia or thrombocytopenia caused by a blood disease. In addition, patients may also receive other blood components to manage coagulopathy or active bleeding. The appropriate use of blood components requires an understanding of the potential risks and benefits.
The transfusion trigger is used to describe a set of conditions under which transfusion is considered to be indicated and for which no further justification is required. It is not a secret to say that the decision to transfuse is always debatable, and setting a universal target transfusion trigger for all patients bypassing different individual variations is a common mistake. Moreover, this decision must be individualized, and each patient should represent a lone call.
The physiological transfusion triggers can be based on signs and symptoms of unpaired global oxygenation {lactate, venous oxygen saturation (SvO2) and central venous oxygen saturation (ScvO2)}.
Allogenic blood transfusion has long been associated with both infectious and non-infectious risks, although today's blood supply is safer than ever from various pathogens, infectious risks have not been completely eliminated because of limitations in current detection methods but still the potential risks of transfusion are far common, exceeding infectious risks. Considering the numerous complications associated with blood transfusion, it is important to develop various strategies to minimize unnecessary transfusions and to ensure the safe and appropriate use of blood and blood components when necessary.
The risks of blood transfusion should always be considered in perspective to the benefits of having red cells, platelets and plasma available to support complex surgical procedures and to correct critical cytopenias and coagulopathies. Accordingly, blood centers and transfusion services will continue to perform research and provide education so that all transfusions risks are appropriately recognized and managed, until ultimately they are reduced to be negligible.
Anemia often develops early in the course of critical illness. The causes of anemia in ICU include blood loss, blunted erythropoietin response, inflammation and increased RBCs destruction.
The established method for managing anemia in the ICU is allogeneic red cell transfusion. The key question in deciding how to use red cell transfusion in the ICU, is identifying the most appropriate transfusion trigger and the target haemoglobin range for each patient.
Recombinant human erythropoietin (rHuEPO) may represent a therapeutic option for the treatment of anemia of critical illness and an additional way to conserve RBCs in the ICU.
Thrombocytopenia is very common in critically ill patients treated in the ICU. It is caused by is caused by many reasons such as immune-mediated thrombocytopenia, drugs or toxins, intra-aortic balloon pump/intravascular device use, hypersplenism and microangiopathic hemolytic anemia as DIC.
DIC is common in ICU patients, as it is a comorbidity of many of the diagnoses, which lead to ICU admission. While DIC is not a primary disorder, it is a marker of an underlying systemic process.Treatment of DIC is treatment of the underlying disorder aggressively, restoration of adequate circulatory volume and coagulation potential as quickly as possible.
Blood transfusions can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood loss during surgery. Blood transfusions may be also used to treat severe anemia or thrombocytopenia caused by a blood disease. In addition, patients may also receive other blood components to manage coagulopathy or active bleeding. The appropriate use of blood components requires an understanding of the potential risks and benefits.
The transfusion trigger is used to describe a set of conditions under which transfusion is considered to be indicated and for which no further justification is required. It is not a secret to say that the decision to transfuse is always debatable, and setting a universal target transfusion trigger for all patients bypassing different individual variations is a common mistake. Moreover, this decision must be individualized, and each patient should represent a lone call.
The physiological transfusion triggers can be based on signs and symptoms of unpaired global oxygenation {lactate, venous oxygen saturation (SvO2) and central venous oxygen saturation (ScvO2)}.
Allogenic blood transfusion has long been associated with both infectious and non-infectious risks, although today's blood supply is safer than ever from various pathogens, infectious risks have not been completely eliminated because of limitations in current detection methods but still the potential risks of transfusion are far common, exceeding infectious risks. Considering the numerous complications associated with blood transfusion, it is important to develop various strategies to minimize unnecessary transfusions and to ensure the safe and appropriate use of blood and blood components when necessary.
The risks of blood transfusion should always be considered in perspective to the benefits of having red cells, platelets and plasma available to support complex surgical procedures and to correct critical cytopenias and coagulopathies. Accordingly, blood centers and transfusion services will continue to perform research and provide education so that all transfusions risks are appropriately recognized and managed, until ultimately they are reduced to be negligible.
Other data
| Title | Blood Disorders in Critically Ill Patients | Other Titles | اضطرابات الدم فى المرضى ذوى الحالات الحرجة | Authors | Abubakr Ahmed Abdou Mohammed | Issue Date | 2016 |
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