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Anaemia critical care

S L Rygård, L B Holst, J Wetterslev, P I Johansson, A Perner
BACKGROUND: Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. METHODS: In post-hoc analyses of the full trial population of 998 patients from the Transfusion Requirements in Septic Shock (TRISS) trial, we investigated the intervention effect on 90-day mortality in patients with severe comorbidity (chronic lung disease, haematological malignancy or metastatic cancer), in patients who had undergone surgery (elective or acute) and in patients with septic shock as defined by the new consensus definition: lactate above 2 mmol/l and the need for vasopressors to maintain a mean arterial pressure above 65 mmHg...
December 2, 2016: Acta Anaesthesiologica Scandinavica
Edward Litton, Stuart Baker, Wendy N Erber, Shannon Farmer, Janet Ferrier, Craig French, Joel Gummer, David Hawkins, Alisa Higgins, Axel Hofmann, Bart De Keulenaer, Julie McMorrow, John K Olynyk, Toby Richards, Simon Towler, Robert Trengove, Steve Webb
PURPOSE: Both anaemia and allogenic red blood cell transfusion are common and potentially harmful in patients admitted to the intensive care unit. Whilst intravenous iron may decrease anaemia and RBC transfusion requirement, the safety and efficacy of administering iron intravenously to critically ill patients is uncertain. METHODS: The multicentre, randomized, placebo-controlled, blinded Intravenous Iron or Placebo for Anaemia in Intensive Care (IRONMAN) study was designed to test the hypothesis that, in anaemic critically ill patients admitted to the intensive care unit, early administration of intravenous iron, compared with placebo, reduces allogeneic red blood cell transfusion during hospital stay and increases the haemoglobin level at the time of hospital discharge...
September 30, 2016: Intensive Care Medicine
Akshay Shah, Noémi B Roy, Stuart McKechnie, Carolyn Doree, Sheila A Fisher, Simon J Stanworth
BACKGROUND: Anaemia affects 60-80 % of patients admitted to intensive care units (ICUs). Allogeneic red blood cell (RBC) transfusions remain the mainstay of treatment for anaemia but are associated with risks and are costly. Our objective was to assess the efficacy and safety of iron supplementation by any route, in anaemic patients in adult ICUs. METHODS: Electronic databases (CENTRAL, MEDLINE, EMBASE) were searched through March 2016 for randomized controlled trials (RCT)s comparing iron by any route with placebo/no iron...
September 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
Cristiane Campello Bresani Salvi, Maria Cynthia Braga, José Natal Figueirôa, Malaquias Batista Filho
BACKGROUND: Treatment of maternal iron-deficiency anaemia can reduce risks of prematurity and low birth weight; hence a reliable diagnosis of maternal iron needs is critical. However, erythrocyte indices and serum ferritin have shown a weak correlation with iron status during pregnancy. This study verified the accuracy of those tests to predict the responsiveness to a therapeutic test with oral iron as reference standard for iron deficiency in pregnant women. METHODS: A prospective diagnostic study phase 3 was conducted in a single prenatal care center in Northeast Brazil...
2016: BMC Pregnancy and Childbirth
R M Surve, R Muthuchellappan, G S U Rao, M Philip
BACKGROUND: Literature suggests poorer outcomes during anaemia as well as following red blood cell transfusion (BT) in brain injured patients. Recently, central venous oxygen saturation (ScvO2 ) has been proposed as a physiological trigger to guide red BT. In this study, we looked at ScvO2 changes following BT in patients admitted to a neurointensive care unit (NICU). STUDY DESIGN: In this prospective, observational study, adult, acutely ill neurological patients of >18 years were recruited...
August 1, 2016: Transfusion Medicine
Jonah Powell-Tuck, Siobhan Crichton, Mario Raimundo, Luigi Camporota, Duncan Wyncoll, Marlies Ostermann
BACKGROUND: In hospitalised patients, anaemia increases the risk of developing acute kidney injury (AKI). Our aim was to determine whether anaemia also has an impact on the risk of progression from early AKI to more severe AKI in critically ill patients. METHODS: We retrospectively analysed the data of patients admitted to the adult intensive care unit between 2007 and 2009 who had AKI I as per the AKI Network classification, and who had undergone haemodynamic monitoring within 12 h of AKI I...
March 8, 2016: Critical Care: the Official Journal of the Critical Care Forum
Sethina Watson, Kate Kendrick
Anaemia in intensive care is common, with approximately 50% of patients receiving a red cell transfusion. Recognised complications from transfusion include 'transfusion associated lung injury', infection, and organ failure progression. Most cohort studies show a positive relationship between red cell transfusion and adverse outcomes. In 2012, the British Committee for Standards in Haematology issued guidelines for red cell (RBC) transfusion in critical care. They recommend a haemoglobin transfusion trigger of below 70 g/dL unless the patient is bleeding, has acute sepsis, neurological injury, or an acute coronary syndrome...
2014: BMJ Quality Improvement Reports
O Goren, I Matot
Perioperative acute kidney injury (AKI) is not uncommon and is associated with considerable morbidity and mortality. Recently, several definition systems for AKI were proposed, incorporating both small changes of serum creatinine and urinary output reduction as diagnostic criteria. Novel biomarkers are under investigation as fast and accurate predictors of AKI. Several special considerations regarding the risk of AKI are of note in the surgical patient. Co-morbidities are important risk factors for AKI. The surgery in itself, especially emergency and major surgery in the critically ill, is associated with a high incidence of AKI...
December 2015: British Journal of Anaesthesia
Katherine Plewes, Richard J Maude, Aniruddha Ghose, Arjen M Dondorp
BACKGROUND: Severe falciparum malaria may be complicated by prolonged haemolysis and recurrent fever after parasite clearance. However, their respective etiologies are unclear and challenging to diagnose. We report the first case of severe falciparum malaria followed by prolonged haemolytic anaemia and rhinomaxillary mucormycosis in a previously healthy adult male. CASE PRESENTATION: A 30-year old Bangladeshi man was admitted with severe falciparum malaria complicated by hyperlactataemia and haemoglobinuria...
2015: BMC Infectious Diseases
Batool A Haider, Zulfiqar A Bhutta
BACKGROUND: Multiple-micronutrient (MMN) deficiencies often coexist among women of reproductive age in low- to middle-income countries. They are exacerbated in pregnancy due to the increased demands, leading to potentially adverse effects on the mother and developing fetus. Though supplementation with MMNs has been recommended earlier because of the evidence of impact on pregnancy outcomes, a consensus is yet to be reached regarding the replacement of iron and folic acid supplementation with MMNs...
November 1, 2015: Cochrane Database of Systematic Reviews
Amanda J Ullman, Samantha Keogh, Fiona Coyer, Deborah A Long, Karen New, Claire M Rickard
BACKGROUND: Anaemia is common in critically ill patients, and has a significant negative impact on patients' recovery. Blood conservation strategies have been developed to reduce the incidence of iatrogenic anaemic caused by sampling for diagnostic testing. OBJECTIVES: Describe practice and local guidelines in adult, paediatric and neonatal Australian intensive care units (ICUs) regarding blood sampling and conservation strategies. METHODS: Cross-sectional descriptive study, conducted July 2013 over one week in single adult, paediatric and neonatal ICUs in Brisbane...
May 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Sibylle A Kozek-Langenecker
PURPOSE OF REVIEW: Infusion therapy is essential in intravascular hypovolaemia and extravascular fluid deficits. Crystalloidal fluids and colloidal volume replacement affect blood coagulation when infused intravenously. The question remains if this side-effect of infusion therapy is clinically relevant in patients with and without bleeding manifestations, and if fluid-induced coagulopathy is a risk factor for anaemia, blood transfusion, and mortality, and a driver for resource use and costs...
August 2015: Current Opinion in Critical Care
Albert Lloret, Diane D Addie, Corine Boucraut-Baralon, Herman Egberink, Tadeusz Frymus, Tim Gruffydd-Jones, Katrin Hartmann, Marian C Horzinek, Margaret J Hosie, Hans Lutz, Fulvio Marsilio, Maria Grazia Pennisi, Alan D Radford, Etienne Thiry, Uwe Truyen, Karin Möstl
OVERVIEW: Cytauxzoon species are apicomplexan haemoparasites, which may cause severe disease in domestic cats, as well as lions and tigers. For many years, cytauxzoonosis in domestic cats was only reported in North and South America, but in recent years the infection has also been seen in Europe (Spain, France and Italy). INFECTION: Cytauxzoon felis is the main species; it occurs as numerous different strains or genotypes and is transmitted via ticks. Therefore, the disease shows a seasonal incidence from spring to early autumn and affects primarily cats with outdoor access in areas where tick vectors are prevalent...
July 2015: Journal of Feline Medicine and Surgery
Jurjen J Boonstra, Anne A Kan, Irma de Vries, Vera H M Deneer, Arend-Jan Meinders
BACKGROUND: Approximately ten times a year the Dutch National Poisons Information Centre (NVIC) is consulted regarding a colchicine intoxication or overdose. CASE DESCRIPTION: An 18-year old woman was admitted to the intensive care unit after a suicide attempt with a potentially lethal dosage of colchicine tablets (0.5 mg/kg body weight). After a few hours the patient developed abdominal pain and vomited. Over subsequent days she developed anaemia, thrombocytopenia and a paralytic ileus...
2015: Nederlands Tijdschrift Voor Geneeskunde
Sigismond Lasocki, Thomas Gaillard, Emmanuel Rineau
Iron as an element is a double-edged sword, essential for living but also potentially toxic through the generation of oxidative stress. The recent study by Chen and colleagues in Critical Care reminds us of this elegantly. In a mouse model of acute lung injury, they showed that silencing hepcidin (the master regulator of iron metabolism) locally in airway epithelial cells aggravates lung injury by increasing the release of iron from alveolar macrophages, which in turn enhances pulmonary bacterial growth and reduces the macrophages' killing properties...
2014: Critical Care: the Official Journal of the Critical Care Forum
Eugene Oteng-Ntim, Benjamin Ayensah, Marian Knight, Jo Howard
We describe the findings from a national study of maternal and fetal outcomes of pregnancy in women with sickle cell disease (SCD). Data were collected via the United Kingdom Obstetric Surveillance System between 1 February 2010 and 31 January 2011 from 109 women, of whom 51 (46·8%) had HbSS and 44 (40·4%) had HbSC. Data included antenatal, maternal and fetal outcomes. Comparisons were made between women with HbSS and HbSC. Incidence of complications were acute pain (57%), blood transfusion (26%), urinary tract infection (UTI; 12%) and critical care unit admission (23%) and these were all more common in women with HbSS than HbSC...
April 2015: British Journal of Haematology
Edward Litton, Stuart Baker, Wendy Erber, Craig French, Janet Ferrier, David Hawkins, Alisa M Higgins, Axel Hofmann, Bart L De Keulenaer, Shannon Farmer, Julie McMorrow, John Olynyk, Toby Richards, Simon Towler, Steve Webb
BACKGROUND: Allogeneic red blood cell (RBC) transfusion is associated with significant increases in mortality and major morbidity in patients admitted to the intensive care unit, and the blood supplies it requires are an increasingly scarce and costly resource. Despite high levels of compliance with recommended transfusion thresholds in the ICU, RBC transfusion remains common. Novel interventions to reduce the incidence of RBC transfusion are required. OBJECTIVE: To describe the study protocol for a randomised controlled trial, the Intravenous Iron or Placebo for Anaemia in Intensive Care (IRONMAN) trial, comparing intravenous (IV) iron with placebo in patients who are admitted to an ICU and are anaemic...
December 2014: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
G M Liumbruno, S Vaglio, G Grazzini, D R Spahn, G Biancofiore
The overall use of allogeneic blood transfusions in clinical practice remains relatively high and still varies widely among centres and practitioners. Moreover, allogeneic blood transfusions have historically been linked with risks and complications: some of them (e.g. transfusion reactions and transmission of pathogens) have been largely mitigated through advancements in blood banking whereas some others (e.g. immunomodulation and transfusion-related acute lung injury) appear to have more subtle etiologies and are more difficult to tackle...
October 2015: Minerva Anestesiologica
M Müller, R Dörfelt, L Hamacher, G Wess
The occurrence of nucleated red blood cells (NRBC) in the peripheral blood of critically ill human patients is associated with increased mortality. In dogs, the presence of NRBCs in peripheral blood has been used as a sensitive and specific marker of complications and outcome associated with heatstroke. However, no study has investigated their prevalence in critically ill dogs. Thus, the aim of this study was to determine the prevalence of NRBCs in the peripheral blood, and to evaluate their occurrence as a prognostic factor in critically ill dogs...
November 22, 2014: Veterinary Record
Shashikala Gv, Shashidhar Pk, Anita Herur, Surekharani Chinagudi, Shailaja S Patil, Roopa B Ankad, Sukanya V Badami
BACKGROUND: Anaemia affects the body by decreased oxygen (O2) carrying capacity of the blood. There is growing evidence that anaemia contributes to cardiac disease and death. It causes O2 supply - demand myocardial mismatch causing myocardial ischemia. There is diversity of opinion available in literature on reports of electrocardiographic (ECG) changes in anaemia. AIM: To study the ECG changes in anemic population and to correlate ECG changes seen with increasing severity of anaemia...
April 2014: Journal of Clinical and Diagnostic Research: JCDR
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