Marion Scharte1, Mitchell P Fink. 1. Klinik und Poliklinik für Anästhesiologie und operativ Intensivmedizin, Universitätsklinikum Münster, Muenster, Germany.
Abstract
OBJECTIVE: Reduction in red blood cell mass, as well as structural and functional alterations of erythrocytes, occurs in critical illness. This review discusses these changes in red blood cell physiology, emphasizing the pathogenesis of anemia in intensive care unit patients. DATA SOURCE: Studies published in biomedical journals. DATA SYNTHESIS AND CONCLUSION: Anemia in intensive care unit patients resembles the anemia of chronic disease, being characterized by diminished erythropoietin production relative to decreased hematocrit, altered iron metabolism, and impaired proliferation and differentiation of erythroid progenitors in the bone marrow. Inflammatory mediators play a major role in the development of insufficient erythropoiesis and altered iron metabolism. Furthermore, a proinflammatory milieu promotes structural and functional alterations of erythrocytes, impairing their deformability and possibly impairing microvascular perfusion. Collectively, these changes in red blood cell physiology can impair oxygen transport to tissues and, thereby, might contribute to the development of multiple organ failure in critical illness.
OBJECTIVE: Reduction in red blood cell mass, as well as structural and functional alterations of erythrocytes, occurs in critical illness. This review discusses these changes in red blood cell physiology, emphasizing the pathogenesis of anemia in intensive care unit patients. DATA SOURCE: Studies published in biomedical journals. DATA SYNTHESIS AND CONCLUSION:Anemia in intensive care unit patients resembles the anemia of chronic disease, being characterized by diminished erythropoietin production relative to decreased hematocrit, altered iron metabolism, and impaired proliferation and differentiation of erythroid progenitors in the bone marrow. Inflammatory mediators play a major role in the development of insufficient erythropoiesis and altered iron metabolism. Furthermore, a proinflammatory milieu promotes structural and functional alterations of erythrocytes, impairing their deformability and possibly impairing microvascular perfusion. Collectively, these changes in red blood cell physiology can impair oxygen transport to tissues and, thereby, might contribute to the development of multiple organ failure in critical illness.
Authors: O Okoye; K Inaba; M Kennedy; A Salim; P Talving; D Plurad; L Lam; D Demetriades Journal: Eur J Trauma Emerg Surg Date: 2013-06-18 Impact factor: 3.693
Authors: Ciara M Shaver; Cameron P Upchurch; David R Janz; Brandon S Grove; Nathan D Putz; Nancy E Wickersham; Sergey I Dikalov; Lorraine B Ware; Julie A Bastarache Journal: Am J Physiol Lung Cell Mol Physiol Date: 2016-01-15 Impact factor: 5.464