Blood conservation in the critically ill

Jennifer Thomas, Anthony Martinez

Research output: Contribution to journalArticle

Abstract

Purpose. Anemia of critical illness is common among intensive care unit patients. A blood management pilot program was initiated to study the pharmacodynamic response of epoetin alfa in critically ill patients and assess the impact of the use of a standardized order set of pharmaceuticals, including epoetin alfa and intravenous iron sucrose, on the quantity of red blood cell units transfused in the adult intensive care unit. Summary. A pre-printed order set was developed which included baseline and follow-up laboratory monitoring and pharmaceutical options for iron, either intravenous and/or oral, folic acid, ascorbic acid, cyancobalamin, and weight-based epoietin alfa. Laboratory studies included: hemoglobin/hematocrit, reticulocyte count, absolute reticulocyte count, immature reticulocyte fraction obtained at baseline, and on day three and day five; in addition, iron, total iron binding capacity, transferrin saturation, and ferritin were obtained at baseline and on day five. An average hemoglobin response of 0.8 g/dL five days after administration of epoetin alfa was demonstrated in a diverse population of critically ill patients. Patients who received intravenous iron did not have a difference in mortality as compared to those patients who did not receive Intravenous iron; however, there was a significantly longer length of stay. The cost of epoetin alfa was $64,000 over 10 months (approximately 8-10 patients/month). Transfusions of RBCs in adult intensive care unit decreased over the initial five months of the pilot study. Conclusion. Use of erythropoiesis stimulating agents (ESAs) in the critically ill is controversial. Implementing a standardized approach in the pharmaceutical management of anemia in the critically ill patient is possible. Limitations with the order set and standardized protocol included errors in selection of dose/weight, incomplete laboratory/monitoring, and inconsistent prospective/concurrent review to guide therapy. The determination of the cost-effectiveness of epoetin alfa therapy in anemia of critical illness was not the purpose of this project, but will be the focus of future studies.

Original languageEnglish (US)
JournalAmerican Journal of Health-System Pharmacy
Volume64
Issue number16 SUPPL.
DOIs
StatePublished - Aug 15 2007

Fingerprint

Epoetin Alfa
Critical Illness
Iron
Reticulocyte Count
Intensive Care Units
Anemia
saccharated ferric oxide
Concurrent Review
Hemoglobins
Pharmaceutical Preparations
Hematinics
Weights and Measures
Reticulocytes
Transferrin
Ferritins
Hematocrit
Folic Acid
Ascorbic Acid
Cost-Benefit Analysis
Length of Stay

Keywords

  • Anemia
  • Ascorbic acid
  • Blood
  • Costs
  • Critical illness
  • Cyanocobalamin
  • Dosage
  • Epoetin alfa
  • Errors, medication
  • Folic acid
  • Hematopoietic agents
  • Hospitals
  • Iron preparations
  • Iron sucrose
  • Mortality
  • Vitamins

ASJC Scopus subject areas

  • Pharmaceutical Science
  • Leadership and Management

Cite this

Blood conservation in the critically ill. / Thomas, Jennifer; Martinez, Anthony.

In: American Journal of Health-System Pharmacy, Vol. 64, No. 16 SUPPL., 15.08.2007.

Research output: Contribution to journalArticle

Thomas, Jennifer ; Martinez, Anthony. / Blood conservation in the critically ill. In: American Journal of Health-System Pharmacy. 2007 ; Vol. 64, No. 16 SUPPL.
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